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Management Results of a Series of Predominantly Delayed Operations on Ruptured Aneurysms

  • W. Krupp
  • W. Heienbrok
  • R. Müke
Conference paper
Part of the Advances in Neurosurgery book series (NEURO, volume 20)

Abstract

Using a comprehensive statistical analysis, Kassell and Drake [9] were able to illustrate the fatal consequences of aneurysmal rupture. Many authors have advocated an early operation to reduce both the rebleeding and vasospasm rates [2, 4, 11–13, 21]. Nevertheless, the results of early operations have been varied and, in their interpretation, are not uncontroversial. Discussion centered mainly on the range of criteria for an early operation in terms of aneurysm site and grade at the time of admission [1, 5, 7, 9, 10, 15, 20]. A comparison of the various treatment strategies reveals methodological problems due to differences in selection when the patients are allocated to the clinics and due to the choice of outcome parameters [13, 16]. Generally recognized as comparison values are the definitions of management mortality and management morbidity, which were coined by Lougheed [14]. In this paper, we present the management results of a series of predominantly delayed operations on ruptured aneurysms.

Keywords

Intracranial Aneurysm Early Operation Cerebral Aneurysm Glasgow Outcome Scale Aneurysmal Subarachnoid Hemorrhage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Adams HP (1986) Early management of the patient with recent aneurysmal subarachnoid hemorrhage. Stroke 17:1068–1070PubMedCrossRefGoogle Scholar
  2. 2.
    Auer LM (1983) Acute surgery of cerebral aneurysms and prevention of symptomatic vasospasm. Acta Neurochir (Wien) 69:273–281CrossRefGoogle Scholar
  3. 3.
    Auer LM, Brandt L, Ebeling U, Gilsbach J, Groeger U, Harders A, Ljunggren B, Oppel F, Reulen HJ, Saeveland H (1986) Nimodipine and early aneurysm operation in good condition SAH patients. Acta Neurochir 82:7–13CrossRefGoogle Scholar
  4. 4.
    Ausman JI, Diaz FG, Malik GM, Fielding AS, Son CS (1985) Current management of cerebral aneurysms: Is it based on facts or myths? Surg Neurol 24:625–635PubMedCrossRefGoogle Scholar
  5. 5.
    Chyatte D, Fode NC, Sundt TM (1988) Early versus late intracranial aneurysm surgery in subarachnoid hemorrhage. J Neurosurg 69:326–331PubMedCrossRefGoogle Scholar
  6. 6.
    Disney L, Weir B, Petruk K (1987) Effect on management mortality of deliberate policy of early operation on supratentorial aneurysms. Neurosurgery 20:695–701PubMedCrossRefGoogle Scholar
  7. 7.
    Flamm ES (1986) The timing of aneurysm surgery 1985. Clin Neurosurg 33:147–158PubMedGoogle Scholar
  8. 8.
    Gilsbach JM, Harders AG (1989) Morbidity and mortality after early aneurysm surgery — a prospective study with nimodipine prevention. Acta Neurochir 96:1–7CrossRefGoogle Scholar
  9. 9.
    Kassell NF, Drake CG (1982) Timing of aneurysm surgery. Neurosurgery 10:514–519PubMedCrossRefGoogle Scholar
  10. 10.
    Kassell NF, Kongable GL, Torner JC, Adams HP, Mazuz H (1985) Delay in referral of patients with ruptured aneurysms to neurosurgical attention. Stroke 16:587–590PubMedCrossRefGoogle Scholar
  11. 11.
    Ljunggren B, Brandt L, Kagström E, Sundbärg G (1981) Results of early operations for ruptured aneurysms. J Neurosurg 54:473–479PubMedCrossRefGoogle Scholar
  12. 12.
    Ljunggren B, Brandt L, Säveland H, Nilson PE, Cronqvist S, Andersson KE, Vinge E (1984) Outcome in 60 consecutive patients treated with early aneurysm operation and intravenous nimodipine. J Neurosurg 61:864–873PubMedCrossRefGoogle Scholar
  13. 13.
    Ljunggren B, Säveland H, Brandt L, Zygmunt S (1985) Early operation and overall outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 62:547–551PubMedCrossRefGoogle Scholar
  14. 14.
    Lougheed WM (1969) Selection, timing, and technique of aneurysm surgery of the anterior circle of Willis. Clin Neurosurg 16:95–113PubMedGoogle Scholar
  15. 15.
    Marsh H, Maurice-Williams RS, Lindsay KW (1987) Differences in the management of ruptured intracranial aneurysms: a survey of practice amongst British neurosurgeons. J Neurol Neurosurg Psychiatry 50:965–970PubMedCrossRefGoogle Scholar
  16. 16.
    Maurice-Williams RS, Marsh H (1985) Ruptured intracranial aneurysms: the overall effect of treatment and the influence of patient selection and data presentation on the reported outcome. J Neurol Neurosurg Psychiatry 48:1208–1212PubMedCrossRefGoogle Scholar
  17. 17.
    Milhorat TH, Krautheim M (1985) Results of early and delayed operation for ruptured intracranial aneurysms in two series of 100 consecutive patients. Surg Neurol 26:123–128CrossRefGoogle Scholar
  18. 18.
    Öhman J, Heiskanen O (1988) Effect of nimodipine on the outcome of patients after aneurysmal subarachnoidal hemorrhage and surgery. J Neurosurg 69:683–686PubMedCrossRefGoogle Scholar
  19. 19.
    Ropper AH, Zervas NT (1984) Outcome 1 year after SAH from cerebral aneurysm. Management morbidity, mortality, and functional status in 112 consecutive good-risk patients. J Neurosurg 60:909–915PubMedCrossRefGoogle Scholar
  20. 20.
    Säveland H, Ljunggren B, Brandt L, Messeter K (1986) Delayed ischemic deterioration in patients with early aneurysm operation and intravenous nimodipine. Neurosurgery 18:146–150PubMedCrossRefGoogle Scholar
  21. 21.
    Sakaki S, Onta S, Kuwabara H, Shiraishi M (1987) The role of ventricular and cisternal drainage in the early operation for ruptured intracranial aneurysms. Acta Neurochir 88:87–94CrossRefGoogle Scholar
  22. 22.
    Seiler RW, Reulen HJ, Huber P, Grolimund P, Ebeling U, Steiger HJ (1988) Outcome of aneurysmal subarachnoid hemorrhage in a hospital population: a prospective study including early operation, intravenous nimodipine, and transcranial Doppler ultrasound. Neurosurgery 23:598–604PubMedCrossRefGoogle Scholar
  23. 23.
    Taneda M (1982) The significance of early operation in the management of ruptured intracranial aneurysms — an analysis of 251 cases hospitalized within 24 hours after subarachnoid haemorrhage. Acta Neurochir (Wien) 63:201–208CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • W. Krupp
  • W. Heienbrok
  • R. Müke
    • 1
  1. 1.Neurochirurgische KlinikAlfried-Krupp-KrankenhausEssenGermany

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