Comparative Analysis of Single-Stage vs. Multiple-Stage Interventions in the Management of Subarachnoid Hemorrhage in Patients with Multiple Intracranial Aneurysms

TL;DR

This study compares single and multiple-stage treatments for brain aneurysms after a hemorrhage, finding that single-stage approaches may increase risks like vasospasm.

Contribution

The study provides new insights into the comparative risks and outcomes of single-stage versus multiple-stage interventions for multiple intracranial aneurysms following subarachnoid hemorrhage.

Findings

Single-stage interventions were associated with a significantly higher occurrence of vasospasm compared to multiple-stage procedures.

There was a trend toward worse neurological outcomes and post-operative deficits in the single-stage group, though not statistically significant.

Baseline differences between groups and limited statistical adjustment suggest caution in interpreting the results.

Abstract

Background/Objectives: Subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms remains a critical neurosurgical emergency with high morbidity and mortality. The presence of multiple intracranial aneurysms (MIAs) in SAH patients presents a therapeutic challenge, particularly in choosing between single-stage and multiple-stage interventions. In patients with aneurysmal SAH and multiple intracranial aneurysms, we compared single-stage vs. multiple-stage interventions regarding vasospasm occurrence, complication rates, and short-term neurological outcomes in a retrospective cohort. Methods: This retrospective cohort study included 44 patients diagnosed with aneurysmal SAH and at least one additional unruptured aneurysm. Patients were categorized based on the intervention strategy. A “single-stage” intervention was defined as treatment of both the ruptured and all unruptured aneurysms in the same operative session. A “multiple-stage” intervention referred to a planned approach in which additional aneurysms were treated in separate, subsequent procedures. Clinical severity was assessed using scores. Aneurysm characteristics and treatment modalities were recorded. Outcomes were analyzed and compared between intervention groups. Statistical analysis was performed, with p < 0.05 considered significant. Results: The cohort included 44 patients with a total of 109 aneurysms. Most patients were female (68.2%), with a mean age of 54.5 years. The majority of aneurysms were small- to medium-sized and commonly located in the anterior circulation. Among the patients, 19.0% underwent single-stage interventions, and 28.6% underwent multiple-stage procedures. Vasospasm occurred significantly more often in the single-stage group (83.9% vs. 46.2%, p = 0.028). No significant difference was found in hospital stay duration between groups. The MRS scores showed a trend toward worse outcomes in the single-stage group (p = 0.060), as did the rates of post-operative neurological deficits (p = 0.079). Conclusions: In patients with SAH and MIAs, single-stage interventions may increase vasospasm risk. Although they offer logistical benefits, outcomes should be interpreted with caution given baseline differences and limited statistical adjustment.

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