Analysis of diagnosis and treatment of traumatic subarachnoid hemorrhage combined with aneurysm
Objective To preliminarily explore the effective diagnosis and treatment for traumatic subarachnoid hemorrhage(tSAH)combined with arterial aneurysm.Methods A retrospective analysis was conducted on clinical data of patients with tSAH combined with arterial aneurysm admitted to the Department of Neurosurgery of Shenzhen Second People's Hospital from November 2013 to May 2021,which accounted for 3.24％(11/339)of the patients with tSAH admitted in the same period.The aneurysms were located in the extracranial segment of the internal carotid artery in 1 case,the cavernous sinus segment of the internal carotid artery in 3,the ophthalmic segment of the internal carotid artery in 5,the middle cerebral artery in 1,and the anterior cerebral artery in 1.The diagnosis was confirmed preoperatively by CT angiography(CTA)or digital subtraction angiography(DSA)examination.Based on the location of the bleeding and its positional relationship to the aneurysm,patients were classified into those with aneurysmal subarachnoid hemorrhage(aSAH,6 cases)and non-aneurysmal subarachnoid hemorrhage(non-aSAH,5 cases),and then different therapeutic regimens were implemented.Of the 6 patients with aSAH,craniotomy for aneurysm clipping was performed in 1 case and endovascular embolization in 5 cases.Conservative treatment was performed in 5 non-aSAH cases.Postoperative complications were documented and evaluated.Clinical follow-up was performed.The outcomes of the patients were evaluated using the Glasgow Outcome Scale(GOS),and the aneurysm was assessed by imaging follow-up.Results Among 6 patients with aSAH,1 patient treated with aneurysm clipping had complete aneurysm clipping without intraoperative complications.DSA examination 12 d after surgery revealed recurrence and the aneurysm was completely embolized after endovascular embolization.The aneurysms were completely occluded in the other 5 patients treated with endovascular embolization(Raymond grade Ⅰ)and none had surgery-related complications.All 6 patients were followed up for 6 months.CTA showed no recurrence.GOS grade was Ⅱin1 case,Ⅲ in 1 and Ⅴ in 4.Five patients with TB1 with non-aSAH underwent digital re-examination and no aneurysmal rupture during the follow-up period was found.At the last follow-up,there was 1 case of GOS grade Ⅳ and 4 cases of grade Ⅴ.Conclusions Preliminary study shows that the incidence of SAH combined with an aneurysm after TBI is low.Early diagnosis,management of risk factors and active treatment can help improve the patients'outcomes.
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