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Effects of Posterior Fossa Decompression in Hunt and Hess Grade V Subarachnoid Hemorrhage Patients after Endovascular Trapping of Ruptured Vertebral Artery Dissecting Aneurysms.

World Neurosurg. 2018 Aug 07;:

Authors: Chen CC, Cheng CT, Hsieh PC, Chen CT, Wu YM, Chang CH, Yi-Chou Wang A

Abstract
BACKGROUND: A ruptured vertebral artery dissecting aneurysm (VADA) with a high clinical grade (Hunt and Hess [H&H] grade V) has a devastating prognosis. Because of the high rebleeding nature and location, the rapid mortality can occur in patients due to brainstem compression. Adjuvant decompression of the posterior fossa (PF) after aneurysm secured might improve the outcomes of these patients.
METHODS: Between January 2011 and December 2016, 22 patients who presented with H&H Gr. V ruptured VADAs underwent endovascular treatment. The patients were divided into 2 groups: Group 1 (n = 12) received conventional endovascular treatment of the VADA and external ventricular drainage (EVD), and Group 2 (n = 10) received EVD and suboccipital craniectomy for PF decompression (PFD), following a rapid endovascular trapping of the VADA.
RESULTS: In Group 2, the survival rate and good clinical outcome rate (modified Rankin scale ≤ 2) were 80% and 60%, respectively, which were favorable to the corresponding rates in Group 1 (66.67% and 16.67%). Moreover, 80% of patients (8/10) in Group 2 regained consciousness, compared with 50% of patients in Group 1.
CONCLUSION: An adjuvant decompression of the posterior fossa can improve outcomes in patients with grade V ruptured VADAs.

PMID: 30096506 [PubMed – as supplied by publisher]

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