Allan Taylor1, David Le Feuvre. 1. Division of Neurosurgery, Department of Surgery, Groote Schuur Hospital and University of Cape Town.
Abstract
OBJECTIVES: Neuro-endovascular treatment was introduced at Groote Schuur Hospital in 2001. We sought to assess whether this has resulted in a change in overall outcomes for patients treated for cerebral aneurysms. DESIGN: Retrospective cohort study. The first cohort included cerebral aneurysm patients seen between 1994 and 1998 when only surgical treatment was available. The second cohort consisted of a group treated using both surgical and endovascular methods between 2002 and 2004. SUBJECTS: Patients with ruptured and unruptured aneurysms were included in the study. OUTCOME MEASURES: The Glasgow Outcome Score (GOS) wasused to assess outcome. The primary comparator between groups was major disability (GOS 3 and 2) and death (GOS 1). RESULTS: Cohorts were comparable regarding age, sex and presenting clinical condition as assessed using the World Federation of Neurological Surgeons grading for subarachnoid haemorrhage. There was an absolute reduction in major disability and death of 16% in the later cohort where 55% of patients had endovascular treatment. CONCLUSIONS: The option of endovascular treatment for cerebral aneurysms at Groote Schuur Hospital has allowed for more rapid treatment of patients, which has reduced morbidity and mortality from re-bleeding. We are also able to select the best treatment option for each patient and believe this has contributed to our improved results.
OBJECTIVES: Neuro-endovascular treatment was introduced at Groote Schuur Hospital in 2001. We sought to assess whether this has resulted in a change in overall outcomes for patients treated for cerebral aneurysms. DESIGN: Retrospective cohort study. The first cohort included cerebral aneurysmpatients seen between 1994 and 1998 when only surgical treatment was available. The second cohort consisted of a group treated using both surgical and endovascular methods between 2002 and 2004. SUBJECTS:Patients with ruptured and unruptured aneurysms were included in the study. OUTCOME MEASURES: The Glasgow Outcome Score (GOS) wasused to assess outcome. The primary comparator between groups was major disability (GOS 3 and 2) and death (GOS 1). RESULTS: Cohorts were comparable regarding age, sex and presenting clinical condition as assessed using the World Federation of Neurological Surgeons grading for subarachnoid haemorrhage. There was an absolute reduction in major disability and death of 16% in the later cohort where 55% of patients had endovascular treatment. CONCLUSIONS: The option of endovascular treatment for cerebral aneurysms at Groote Schuur Hospital has allowed for more rapid treatment of patients, which has reduced morbidity and mortality from re-bleeding. We are also able to select the best treatment option for each patient and believe this has contributed to our improved results.