Management Of Brain Aneurysms By Embolization With Coils In Damascus Hospital

Abstract

Abstract Background: Brain aneurysm incidences and mortality are rising globally (500,000 deaths annually worldwide). Global studies on vascular embolization therapy are still rather few (being a relatively recent method). Our research is the first in Syria about the method of management by vascular embolization (This is due to the severe crises that Syria is currently going through, which have reduced the ability to conduct scientific research, in addition to the fact that this procedure and its tools are only available in a few hospitals). We conducted this research to keep abreast of recent medical developments; vascular embolization therapy is less invasive than surgical treatment. In the end, it will be of greater benefit to society in providing better medical care to individuals, extended life span, and reduced morbidity and mortality. In addition to raising the scientific level of doctors in Syria by conducting research that touches on the reality of Syrian hospitals, we aspire that our study will be a means of helping in the future to provide adequate health awareness to the general community about cerebral aneurysms to reduce the increasing number of deaths. The research aims to study the age and gender of patients with cerebral aneurysms, and the patient's hospitalization, in addition to knowing the patient's history and the risk factors that foreshadow the development of aneurysms. In addition, study the symptoms, signs, method of diagnosing the aneurysm, and its location. The study also aimed to study the proportions of complications, mortality, and recurrences resulting from treatment by embolization and the success rate of the procedure. Finally, we aim to compare and discuss the results of our study with global studies. Materials and Methods: A retrospective study was conducted. The sample in our study consisted of 211 patients with cerebral aneurysms. They were treated by the vascular embolization method at Damascus Hospital between 2009-2020. It is a retrieval statistical study. The files of cerebral aneurysm patients were studied in the archives of Damascus Hospital; it included the patients of a surgical emergency room and a neurosurgery clinic in Damascus Hospital. We selected the sample according to specific acceptance and exclusion criteria. We also tried to mention in our study to all the variants related to cerebral aneurysms, but the patient files do not contain all the required information (For many reasons that cannot be mentioned here). Therefore, we studied all the information that was written down in the patients' files. Data related to this study was collected on paper and then transcribed into Excel. Then the data was entered into the (SPSS) program to extract the percentages of the study variables. The Results: Most of the patients in our study ranged in age from 20 to 50 years in rate 54%. The vast majority of them are female 51%. 37% of patients suffer from hypertension, the percentage of smokers 15%. 82% of aneurysm’s patients were admitted to the hospital emergency department. Most patients complained from headaches 86%, as the rest of the symptoms (seizures, drowsiness, low consciousness, coma, confusion) were 22%, 15%, 16%, 30%, 5% respectively. The average Glasgow criterion in the sample of patients was 13.96. 34% of patients suffered from neck stiffness. It was found that cranial nerve VI was the most affected cranial nerve in the sample, where this nerve was damaged alone in 5% of patients, while the cranial nerves were intact in 87% of the sample. 26% of the patients were admitted to the ICU. Cerebral aneurysm was diagnosed by DSA in 69% of patients, CT and MRI diagnosed the rest of the patients 25% and 6% respectively. It was found that the most common location of cerebral aneurysms is on the conducting arteries in 59% of the total sample of patients. 14% of patients suffered from complications caused by cerebral aneurysms. Arterial embolization procedure was successful in 86% of patients, and clinical symptoms disappeared at 83%. By following up on patients, 4% of them died. The relapse rate in the study was 5%. Conclusion: We recommend conducting future studies with a larger sample size, including several hospitals, to determine the prevalence of cerebrovascular aneurysms in Syria, and comparison of management by embolization and surgical management. In addition, conduct other studies to investigate the most common symptoms experienced by patients before the rupture of an aneurysm. In addition to the necessity of holding educational seminars on cerebral aneurysms and warning of the need for a quick review when feeling any symptoms of aneurysms. Aneurysm screening tests are recommended in people with a family history of aneurysms, because they have a golden chance of treatment if it is detected before the rupture. The latest global recommendations should be followed in the diagnosis, management, and follow-up of patients with cerebral aneurysms. Avoid modifiable risk factors, control hypertension, diabetes mellitus, and all diseases harmful to blood vessels. In addition, avoiding the use of aspirin (and liquefactions in general) in patients with a high risk of aneurysm hemorrhage. It is also preferable to secure embolization tools and provide them in government hospitals (due to their high price and difficulty in securing them). Moreover, seeking to develop doctors’ practical experiences in conducting vascular embolization in Syria. Moreover, conduct an autopsy to find out the real cause of death in Damascus hospital. Patients should also be followed up after being discharged from the hospital to find out the occurrence of complications, relapse, or death due to aneurysm, and take care of the archives of Damascus Hospital and archive them on the computer to avoid damage to patients' paper files and to facilitate access to them when needed. All medical history information must be taken and written in detail, and the results of the clinical examination of patients must be written. In addition to conducting laboratory analysis of aneurysm patients (complete blood count, formula, blood group, cholesterol, lipids, sedimentation rate, CRPS and ESCR results ... etc.) and writing down the results of the surgical procedure, its success rate and the complications resulting from it and the aneurysm itself.