Abdurrahman ÇETİN, Abdullah MESUT

Retrospective evaluation of the patients who were admitted to the emergency department of our hospital due to a brain aneurysm and operated by brain surgery clinic

Aim: In this study, we aimed to evaluate the clinical features of brain aneurysms in patients who were admitted to the emergencydepartment in our hospital.Material and Methods: The records of 91 patients who were admitted to the emergency department for any reason between01.01.2013 and 01.01.2018 and diagnosed with a brain aneurysm after brain- CT-angiography together with aneurysm-relatedsymptoms and were operated were retrospectively screened after the approval of the local ethics committee. The patients’ age,weight, sex, bleeding time, Glasgow coma scale (GCS), Fisher, Yasargil scores, complications, postoperative status, and the presenceof diabetes mellitus were recorded. Brain-CT-angiography was used to record the localization of the aneurysm, its size,Fisher gradingscale, projection, anatomical variation, whether it was multiple or incidental, he presence of intraventricular hemorrhage and SAH.Results: There was a statistically significant and strong negative correlation between GCS and Fisher and Yasargil classifications.There was a statistically significant and strong positive correlation between the post-op status of the patient and Fisher, Yasargilclassifications and the complications.Conclusion: Whether the patients are admitted to the emergency department with clinical symptoms of an aneurysm or not, whenthe patients are diagnosed with an aneurysm, we believe that one of GCS, Fisher, or Yasargil classifications will reflect the patient’sclinical status, vasospasm status if SAH is present, post-op status, and complications. We think that the location, size, and projectionof the aneurysms are related to the emerging complications and post-op status.

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1. Meurer WJ, Walsh B, Vilke GM, et al. Clinical Guidelines for the Emergency Department Evaluation of Subarachnoid Hemorrhage. J Emerg Med 2016;50:696-701.
2. Rinkel GJ, Djibuti M, Algra A, et al. Prevalence and risk of rupture of intracranial aneurysms a systematic review. Stroke 1998;29:251-6.
3. Broderick JP, Brott TG, Duldner JE, et al. Initial and recurrent bleeding are the major causes of death following subarachnoid hemorrhage. Stroke 1994;25:1342-7.
4. Hop JW, Rinkel GJ, Algra A, et al. Case-fatality rates and functional outcome after subarachnoid hemorrhage a systematic review. Stroke 1997;28:660-4.
5. Fisher C, Kistler J, Davis J. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980;6:1-9.
6. 6.Cesur B, Kaya AH, Bayrı Y, et al. Intracranial aneurysms in childhood; case report. Türk Nöroşirurji Dergisi 2008:18;128- 33.
7. Molyneux AJ, Kerr RS, Birks J, et al. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol 2009;8:427-33.
8. Molyneux A, Group ISATC. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002;360:1267-74.
9. Debrun GM, Aletich VA, Kehrli P, et al.Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience. Neurosurgery 1998;43:1281-95.
10. Cahill WJ, Calvert JH, Zhang JH. Mechanisms of early brain injury after subarachnoid hemorrhage. J Cereb Blood Flow Metab 2006;26:1341-53.
11. Lagares A, Jiménez-Roldán L, Gomez PA, at al. Prognostic value of the amount of bleeding after aneurysmal subarachnoid hemorrhage: a quantitative volumetric study. Neurosurgery 2015;77:898-907.
12. Rosengart AJ, Schultheiss KE, Tolentino J, et al. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke 2007;38:2315-21.
13. de Gans K, Nieuwkamp DJ, Rinkel GJ, et al. Timing of aneurysm surgery in subarachnoid hemorrhage: a systematic review of the literature. Neurosurgery 2002;50:336-42.
14. Kassell NF, Torner JC, Jane JA, et al. The international cooperative study on the timing of aneurysm surgery: Part 2: surgical results. J Neurosurg 1990;73:37-47.
15. Solenski NJ, Haley EC Jr, Kassell NF, et al. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the multicenter cooperative aneurysm Study. Crit Care Med 1995;23:1007-17.
16. Ferguson S, Macdonald RL. Predictors of cerebral infarction in patins with aneurysmal subarachnoidal hemorrhage. Neurosurgery 2007;60:658-67.
17. Kistler JP, Crowell RM, Davis KR, et al. The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan A prospective study. Neurology 1983;33:424.
18. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 2012;43:1711-37.
19. Athar MK, Levine JM. Treatment options for cerebral vasospasm in aneurysmal subarachnoid hemorrhage. Neurotherapeutics 2012;9:37-43.
20. Lawson MF, Neal DW, Mocco J, et al. Rationale for treating unruptured intracranial aneurysms: actuarial analysis of natural history risk versus treatment risk for coiling or clipping based on 14,050 patients in the Nationwide Inpatient Sample database. World Neurosurg 2013;79:472- 8.
21. Wiebers DO, Whisnant JP, Sundt TM Jr, et al. The significance of unruptured intracranial saccular aneurysms. J Neurosurg 1987;66:23-9.
22. Unruptured intracranial aneurysms-risk of rupture and risks of surgical intervention. International Study of Unruptured Intracranial Aneurysms Investigators. N Engl J Med 1998;339:1725-33.
23. Wiebers DO, Whisnant JP, Huston J 3rd, , et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362:103-10.