Abstract
Background/Objectives Numerous clinical trials have attempted to outline criteria for selecting patients for neurosurgical or endovascular management for aneurysmal subarachnoid haemorrhage (aSAH). aSAH can be further complicated by seizures and cerebrovascular vasospasm. However, these trials have found both methods to be near identical in efficacy and patient outcomes. Current clinical guidelines fail to clearly patient selection, particularly within the Australian clinical landscape.
Methods We analysed electronic medical record data from a major South Australian hospital over two years. All patients who underwent management for aSAH and had both a clinical and radiological diagnosis of aSAH were included. Various patient characteristics were recorded as well as which management modality the patient received. Discharge modified Rankin scale (mRS) was also recorded. A good outcome was defined as a discharge mRS less than 2.
Results 128 patients were included in the study of which 82 (64%) patients were female and the mean age was 58.5 (SD: 13.1). 84 (66%) patients underwent an endovascular coiling procedure, 29 (23%) underwent neurosurgical clipping with the remaining patients undergoing conservative management. There was no statistically significant difference between endovascular and neurosurgical approaches when comparing favourable discharge mRS. Middle cerebral artery aneurysms were favoured for neurosurgical approaches (P < 0.001).
Conclusion Our findings were similar to that of previous retrospective and prospective studies. While there were several aneurysm characteristics that favoured one approach over the other. Broadly, selection to endovascular vs neurosurgical management did not contribute to differences in discharge mRS.
