DESFECHOS CLÍNICOS DOS PORTADORES DE ANEURISMA CEREBRAL ROTO TRATADOS PELAS TÉCNICAS MICROCIRÚRGICA OU ENDOVASCULAR: COORTE PROSPECTIVA

Abstract

Introduction: Surgical clipping and endovascular embolization are known to be two currently accepted treatment strategies for brain aneurysms. Several studies comparing the two techniques have been published in the last decades. However, even today, there is a broad debate in the literature about which is the best method for treating intracranial aneurysms. Objective: To evaluate the difference in mortality between patients with subarachnoid hemorrhage submitted to embolization and neurosurgical clipping of ruptured brain aneurysms. Method: Observational, longitudinal, prospective, descriptiveanalytical study was conducted in a tertiary neurosurgery referral hospital from June to December 2021. Patients with clinical and radiological diagnosis of subarachnoid hemorrhage who underwent neurosurgical clipping or aneurysm embolization were included. Patients were followed up during hospitalization and anatomical details of the aneurysm were collected by angiography or angiotomography. The initial clinical picture of the patient was evaluated by the same researchers, who were trained for this, according to the Hunt-Hess and modified Rankin scales, and the presence of risk factors for the development of aneurysms was investigated. In addition, the postoperative clinical evolution, the presence of late ischemia or shunt-dependent hydrocephalus, the length of hospital stay and the Rankin scale at the time of discharge were collected. Comparison between both methods occurred after pairing the patients according to age and Hunt-Hess at admission. Results: 68 patients were placed in each group and several parameters were compared, such as patient age, Hunt-Hess at patient entry, aneurysm size, aneurysm neck, time between ictus and surgical or endovascular treatment and the number of deaths. After pairing, it was observed that patients who underwent embolization had a higher short-term mortality than patients who underwent clipping (8.8% deaths in the microsurgery group versus 30.8% in the endovascular group - p = 0.001). Conclusion: We consider that neurosurgical clipping provides better results in terms of morbidity and mortality; endovascular treatment is the best technique for patients without operative conditions.