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Effects of early hyperbaric oxygen therapy on clinical outcome in postoperative patients with intracranial aneurysm.

OBJECTIVE
To investigate the effects of hyperbaric oxygen (HBO2) in postoperative patients with intracranial aneurysm.


METHODS
A total of 120 patients who underwent clipping of intracranial aneurysm of the anterior circulation were randomized into the HBO2 group (n = 60) or the Control group (n = 60). Compared with the Control group, patients in the HBO2 group received additional HBO2 therapy, which was initiated within one to three days as soon as they were deemed clinically stable, for at least 20 sessions (one session per day). Mean flow velocities of the middle cerebral artery (MCA) on the operative approach side were measured on Days 1, 3, 7, 14 and 21 after operation. CT scans were performed on Days 1, 7, 14 and 21 after surgery to determine the abnormal density volume in the operative area. Cases associated with symptomatic cerebral vasospasm (CVS) were assessed on Days 3, 7 as well as 14, and the functional state determined by Karnofsky Performance Scale (KPS) score was evaluated on Days 3 and 21 after operation. Finally, Glasgow Outcome Scale (GOS) scores were obtained at six months after surgery.


RESULTS
There were no differences between groups in terms of the mean flow velocities of MCA on the operative approach side, the cases with symptomatic CVS, and the KPS scores within three days after surgery (P > 0.05). Compared with those of the Control group, the mean flow velocities of MCA on the operative approach side were significantly lower in the HBO2 group on Days 7 and 14 (P < 0.05 or P < 0.01). On Days 7, 14 and 21, patients in the HBO2 group had smaller HBO2 density volume in the operative region than those in the Control group (P < 0.05). The HBO2 group developed less cases of symptomatic CVS than the Control group did on Days 7 (chi2 = 4.04, P < 0.05) and 14 (chi2 = 4.18, P < 0.05). The KPS scores were higher on Day 21 after surgery in the HBO2 group (P < 0.05). More patients in the HBO2 group achieved GOS scores of 4 and 5 at six months after surgery (chi2 = 6.032, P < 0.05).


CONCLUSIONS
Early HBO2 appears to be beneficial asan adjunctive treatment of postoperative intracranial aneurysm. Attenuating postoperative CVS, brain edema, and cerebral ischemia contributes to the effectiveness of HBO2.