Unlike many other conditions, subarachnoid hemorrhage is a medical emergency that requires immediate attention. Treatment has to be prompt or the patient stands to lose his life. This condition affects the brain and arises when a vein in the brain bursts. The treatments adopted focusing on stopping the damaged caused by the vein eruption and consequent bleeding so that the patient can survive. the patient will need to be hospitalized in order to get suppprtive care. Treatment options include medical procedures such as clipping and endovascular coiling, and the administration of certain medications. In most cases, surgery or medical procedures have to be carried out as medicines alone may not prove to be very effective although the use of beta blocking drugs is also fairly common. That said, no matter which treatment procedure is employed, the patient wil have to be admitted to the hospital and will have to stay in the ICU till the symptoms of the condition disappear.
SAH can be treated in many ways and how the treatment is carried out will be dependent on the approach the doctor takes. The doctor can resort to medical procedures such as endovascular coiling or clipping, which are carried out in the following ways- Neurosurgical clipping requires the administration of general anesthesia before the procedure can be carried out. After the administration of anesthesia, an incision is made in the patient's scalp or just above his/her eyebrow. Next, a small portion of the brain is removed so that the surgeon can gain access to the vein in the brain that has been damaged. This procedure is also referred to as a craniotomy. Once the surgeon finds the damaged vein, he or she will seal it shut with the help of small metal clip that will stay their permanently. Then the flap of the bone removed is replaced and the incision made is stitched back together. In endovascular coiling too general anesthesia is used before the operation. This surgery involves the insertion of a thin tube, which is known as a catheter, into the patient's artery which is located in his groin or leg. This tube is then guided up through the blood vessels in the patient's body to his head and into the damaged vein. Small coils made of platinum are passed into the catheter to the damaged vein so that bleeding can be controlled.
Both neurosurgical clipping and endovascular coiling are recommended for patients whose aneurysm (i.e. the damaged vein in the brain) is close to ruptuting or has ruptured. In the case of older patients, endovascular coiling is preferred.
Elderly patients are generally not fit to go through a neurosurgical clipping as such open operations can be too dangerous for them. Moreover, patients who haven't had a hemorrhage yet may not be considered for surgery either. Moreover, patients with other health complications may not be eligible for any of these procedures.
Side effects are likely when opting for medical procedures to treat SAH. Complications that can arise as a result of neurosurgical clipping include allergic reaction to anesthesia, infections, seizure, stroke and swelling of the brain. As far as endovascular coiling is concerned, the side effects are more or less the same with some additional ones such as blood clots, vasospasm (the narrowing of an artery) and displacement of the coils.
The post-treatment guidelines are different for the different procedures. In the case of neurosurgical clipping, patients will be kept in the ICU for about 48 hours after which they maybe shifted to the general ward. Patients are generally discharged after a few days and may be allowed to resume all of their daily activities such as driving, going to work and even flying after a period of 4 to 6 weeks. Patients who have undergone endovascular clipping may have to stay in the ICU after the surgery for 14 to 21 days if their vein had ruptured. After a stay in the ICU, patients will be shifted to the general ward and maybe discharged within a few days if no complications arise. After coming back home, patients may experience discomfort in their groin or leg and can have ibuprofen to heal the pain. They will also have to drink plenty of water. They will not be allowed to drive or lift anything heavy for 3 days and will be allowed to get back to work after 3 to 5 days. Bathing will only be allowed 24 hours after the operation.
Recovery from endovascular coiling is quick and patients can lead normal lives just a couple of weeks after the operation. Patients who have gone for clipping though may take longer to recover and the period can range from months to years.
Of the two medical procedures involved, neurosurgical clipping is quite expensive and can cost the patient up to Rs 16 lakhs. On the other hand, endovascular coiling will cost just about Rs 2 to 3 lakhs.
No matter which of these medical procedures patients go for, if it's done right, the results of the surgery are permanent. This means patients don't have anything to worry about.
Drugs in the form of beta blockers can be used as alternatives to a surgery. Patients can also get temporary pain relief with the help of drugs such as morphine.