scholarly journals Early surgery of hemorrhaging aneurysms of brain blood vessels

2008 ◽  
Vol 55 (2) ◽  
pp. 17-25
Author(s):  
N.P. Lakicevic
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
High Risk ◽  
Blood Vessels ◽  
Early Surgery ◽  
Intracerebral Hematoma ◽  
Perioperative Treatment ◽  
Delayed Surgery ◽  
The Brain ◽  
Clinical Grading

Comprehension of the natural course of the aneurisms on the blood vessels of the brain has imposed the need for timely surgical treatment. The comfort of delayed surgery, due to the high risk of the rupture had to be overlooked. Early surgery, within the first three days from the rupture of the aneurysm, has a double role - it prevents rupture, but considerably decreases the risk of complications caused by subarachnoid hemorrhage, vasospasm and hydrocephalus. We present the results of the surgical treatment of 710 patients operated during the period from year 1994 until 1996. We point out that the treatment of patients was conducted in conditions that were not standard, due to sanctions. During operations at our disposal most of the time was only one clip and a limited quantity of drugs for the perioperative treatment. Our results show that compulsory candidates for early surgery are small patients in good clinical grading, without associated illnesses. Patients without clinical and angiographic signs of vasospasm may also be operated in the intermediary term. Patients with massive intracerebral hematoma caused by the rupture of the aneurysm who are in a coma should be urgently operated.

Timing of clinical grade assessment and poor outcome in patients with aneurysmal subarachnoid hemorrhage

2012 ◽  
Vol 117 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Elias A. Giraldo ◽  
Jay N. Mandrekar ◽  
Mark N. Rubin ◽  
Stefan A. Dupont ◽  
Yi Zhang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Functional Outcome ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Intracerebral Hematoma ◽  
Poor Functional Outcome ◽  
Poor Outcome ◽  
Grade Assessment ◽  
Clinical Grading

Object Timing of clinical grading has not been fully studied in patients with aneurysmal subarachnoid hemorrhage (SAH). The primary objective of this study was to identify at which time point clinical assessment using the World Federation of Neurosurgical Societies (WFNS) grading scale and the Glasgow Coma Scale (GCS) is most predictive of poor functional outcome. Methods This study is a retrospective cohort study on the association between poor outcome and clinical grading determined at presentation, nadir, and postresuscitation. Poor functional outcome was defined as a Glasgow Outcome Scale score of 1–3 at 6 months after SAH. Results The authors identified 186 consecutive patients admitted to a teaching hospital between January 2002 and June 2008. The patients' mean age (± SD) was 56.9 ± 13.7 years, and 63% were women. Twenty-four percent had poor functional outcome (the mortality rate was 17%). On univariable logistic regression analyses, GCS score determined at presentation (OR 0.80, p < 0.0001), nadir (OR 0.73, p < 0.0001), and postresuscitation (OR 0.53, p < 0.0001); modified Fisher scale (OR 2.21, p = 0.0013); WFNS grade assessed at presentation (OR 1.92, p < 0.0001), nadir (OR 3.51, < 0.0001), and postresuscitation (OR 3.91, p < 0.0001); intracerebral hematoma on initial CT (OR 4.55, p < 0.0002); acute hydrocephalus (OR 2.29, p = 0.0375); and cerebral infarction (OR 4.84, p < 0.0001) were associated with poor outcome. On multivariable logistic regression analysis, only cerebral infarction (OR 5.80, p = 0.0013) and WFNS grade postresuscitation (OR 3.43, p < 0.0001) were associated with poor outcome. Receiver operating characteristic/area under the curve (AUC) analysis demonstrated that WFNS grade determined postresuscitation had a stronger association with poor outcome (AUC 0.90) than WFNS grade assessed upon admission or at nadir. Conclusions Timing of WFNS grade assessment affects its prognostic value. Outcome after aneurysmal SAH is best predicted by assessing WFNS grade after neurological resuscitation.

Outcomes of surgical treatment for ruptured pericallosal artery aneurysms

2018 ◽  
Vol 20 (2) ◽  
pp. 17-26
Author(s):  
V. V. Krylov ◽  
V. G. Dashyan ◽  
I. V. Grigoryev ◽  
V. A. Lukyanchikov ◽  
I. V. Senko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Surgical Outcome ◽  
Intraventricular Hemorrhage ◽  
Aneurysm Rupture ◽  
Early Surgery ◽  
Intracerebral Hematoma ◽  
Study Objective ◽  
Factors Affecting ◽  
Pericallosal Artery

The study objectiveis to assess short-term outcomes of surgical treatment in patients with ruptured pericallosal artery aneurysms (PCAA) and to identify factors affecting treatment outcomes.Materials and methods.Patients with ruptured PCAA (n = 61) were admitted to the Department of Emergency Neurosurgery at the N. V. Sklifosovsky Research Institute for Emergency Medicine for examination and surgical treatment between 01.01.1992 and 31.12.2015.Results.At the moment of discharge, 33 (54.1 %) patients demonstrated good recovery (Glasgow Outcome Scale (GOS) of 5), 9 (14.7 %) patients had moderate disability (GOS 4), 6 (9.9 %) patients had severe disability (GOS 3), and 13 (21.3 %) patients died (GOS of 1). An outcome was rated as favorable if the GOS was 4 or 5 and unfavorable if the GOS was 1–3. The following risk factors were found to be significant for unfavorable surgical outcome: Hunt and Hess grade 4 and 5, presence of intracerebral hematoma and its volume over 20 cm3, recurrent aneurysm rupture, pronounced angiospasm and intraventricular hemorrhage, early surgery (within 1–3 days). The patient»s age and the volume of intraventricular hemorrhage had no impact on the surgical outcome.Conclusion.The choice of an optimal surgery time should be based on the assessment of hemorrhage severity upon admission. Early surgery is recommended for all patients with Hunt and Hess grade I–II, whereas in patients with Hunt and Hess grade V, the intervention should be postponed until the condition is stabilized, unless the severity is associated with a dislocation syndrome due to intracerebral hematoma or occlusive hydrocephalus. In patients with Hunt and Hess grade III–IV, the decision on surgery time should be made for each individual patient according to existing risk factors.

scholarly journals Clinical characteristics and outcome of aneurysmal subarachnoid hemorrhage with intracerebral hematoma

2016 ◽  
Vol 125 (6) ◽  
pp. 1344-1351 ◽  
Author(s):  
Anthony Wan ◽  
Blessing N. R. Jaja ◽  
Tom A. Schweizer ◽  
R. Loch Macdonald
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Early Treatment ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Neurological Status ◽  
Aneurysm Rupture ◽  
Study Data ◽  
Intracerebral Hematoma ◽  
Pia Mater ◽  
Proportional Odds Models ◽  
The Brain

OBJECTIVE Intracerebral hematoma (ICH) with subarachnoid hemorrhage (SAH) indicates a unique feature of intracranial aneurysm rupture since the aneurysm is in the subarachnoid space and separated from the brain by pia mater. Broad consensus is lacking regarding the concept that ultra-early treatment improves outcome. The aim of this study is to determine the associative factors for ICH, ascertain the prognostic value of ICH, and investigate how the timing of treatment relates to the outcome of SAH with concurrent ICH. METHODS The study data were pooled from the SAH International Trialists repository. Logistic regression was applied to study the associations of clinical and aneurysm characteristics with ICH. Proportional odds models and dominance analysis were applied to study the effect of ICH on 3-month outcome (Glasgow Outcome Scale) and investigate the effect of time from ictus to treatment on outcome. RESULTS Of the 5362 SAH patients analyzed, 1120 (21%) had concurrent ICH. In order of importance, neurological status, aneurysm location, aneurysm size, and patient ethnicity were significantly associated with ICH. Patients with ICH experienced poorer outcome than those without ICH (OR 1.58; 95% CI 1.37–1.82). Treatment within 6 hours of SAH was associated with poorer outcome than treatment thereafter (adjusted OR 1.67; 95% CI 1.04–2.69). Subgroup analysis with adjustment for ICH volume, location, and midline shift resulted in no association between time from ictus to treatment and outcome (OR 0.99; 95% CI 0.94–1.07). CONCLUSIONS The most important associative factor for ICH is neurological status on admission. The finding regarding the value of ultra-early treatment suggests the need to more robustly reevaluate the concept that hematoma evacuation of an ICH and repair of a ruptured aneurysm within 6 hours of ictus is the most optimal treatment path.

Orbitocraniobasal Approach for Anterior Communicating Artery Aneurysms

Neurosurgery ◽  
1986 ◽  
Vol 18 (3) ◽  
pp. 367-369 ◽  
Author(s):  
Kazuhiko Fujitsu ◽  
Takeo Kuwabara
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Skull Base ◽  
Acute Stage ◽  
Anterior Communicating Artery ◽  
Ruptured Aneurysms ◽  
Anterior Communicating Artery Aneurysms ◽  
The Brain

Abstract We describe an orbitofrontotemporobasal craniotomy technique that allows excellent access to anterior communicating artery aneurysms. This orbitocraniobasal approach is particularly useful for the surgical treatment of ruptured aneurysms in the acute stage of subarachnoid hemorrhage, when retraction of the brain needs to be kept to a minimum. With this approach, retraction of the orbital contents decreases the amount of retraction of the brain to such an extent that a brain spatula is not necessary for access to the anterior communicating artery complex. The procedure is described, as is a modification of the approach for removal of large tumors on the skull base.

scholarly journals Excellent Outcome after Early Surgery for Ruptured Middle Cerebral Artery Aneurysm Complicated with Intracerebral and Intraventricular Hemorrhage: A Case Report

2015 ◽  
Vol 69 (1) ◽  
pp. 48-50
Author(s):  
Venko Filipce ◽  
Aleksandar Caparoski ◽  
Tomi Kamiloski ◽  
Dejan Daskalov
Keyword(s):  
Intraventricular Hemorrhage ◽  
Artery Aneurysm ◽  
Early Surgery ◽  
Successful Outcome ◽  
Intracerebral Hematoma ◽  
Middle Cerebral Artery Aneurysm ◽  
Excellent Outcome ◽  
Ruptured Intracranial Aneurysm ◽  
Cerebral Artery Aneurysm ◽  
The Brain

Abstract Intracerebral hematoma and intraventricular hemorrhage can significantly worsen the neurological condition of patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm. They also significantly affect the outcome of this patiens. We present a case in which early surgery had a significant effect on the outcome of this patient. Early decompression of the brain and subsequent clipping of the aneurysm as presented in our case has lead to a successful outcome.

scholarly journals Results of the surgical treatment of patients with brain cavernoma that manifested by intracerebelar hemorrhage

2008 ◽  
Vol 55 (2) ◽  
pp. 129-132
Author(s):  
V.T. Jovanovic ◽  
G.M. Tasic ◽  
B.M. Djurovic ◽  
I.M. Nikolic ◽  
Lj.B. Vujotic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Operative Treatment ◽  
Clinical Presentation ◽  
Vascular Lesion ◽  
Pineal Region ◽  
Intracerebral Hematoma ◽  
Surgical Interventions ◽  
Long Time ◽  
Cerebral Cavernoma ◽  
The Brain

Although, for a long time, they have been known as a kind of vascular lesion, cavernomas have mostly been incidental or causative autopsy finding or have subsequently been histologically confirmed after surgical interventions undertaken due to intracerebral and spinal spontaneous hematoma of various localization. The aim of this study was to establish on the basis of the outcome of the operative treatment, whether the surgical interventions were justified and to systematize indications for surgical treatment of the cerebral cavernoma that initially manifested by hemorrhage. The subject of the study was a group of 38 patients who had been operated at the Institute for Neurosurgery during a ten-year period, from 1990 until 2000. The study group consisted of 16 male and 22 female patients. All operated patients had cyst intraparenchymal lesions. In our group of surgically treated patients three had been treated urgently due to spontaneous intracerebral hematoma, and intraoperatively taken material after inspection of the cavum pointed to the fact that cavernoma had been the cause of hemorrhage. All the others, after postoperatively done MRI of the brain, in some even DSA, were completely evaluated, and histologically confirmed. Not one hemorrhaging cavernoma showed signs of subarachnoid hemorrhage, although 60% of operated patients had cortically localized lesion Most of the operated patients, except for the three mentioned because of urgent intervention did not give massive intraparenchymal lesion that, in the clinical picture, would lead to the change of the state of consciousness. Focal neurologic deficit was a dominant clinical presentation. On the basis of the analysis of the clinically pathologic correlations and direct and longstanding operative results of the surgical treatment of cavernoma, operative treatment is indicated in all superficial lobar lesions as well as in those that are localized in the brain chambers and pineal region regardless of the type of the clinical presentation.

Variation in Patient Characteristics and Outcomes Between Early and Delayed Surgery in Poor-Grade Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2015 ◽  
Vol 78 (2) ◽  
pp. 224-231 ◽  
Author(s):  
Bing Zhao ◽  
Xianxi Tan ◽  
Yuanli Zhao ◽  
Yong Cao ◽  
Jun Wu ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Patient Characteristics ◽  
Early Surgery ◽  
World Federation ◽  
Poor Grade ◽  
Excellent Outcome ◽  
Delayed Surgery ◽  
Fisher Grade ◽  
Middle Cerebral Artery Aneurysms

ABSTRACT BACKGROUND: There is no consensus regarding the optimal timing for surgery for poor-grade aneurysmal subarachnoid hemorrhage. OBJECTIVE: To retrospectively evaluate variation in patient characteristics and outcomes between early and delayed surgery groups. METHODS: Poor-grade aneurysmal subarachnoid hemorrhage was defined as a World Federation of Neurosurgical Societies grade of IV or V after resuscitation. Early surgery was defined as surgery performed within 72 hours of ictus, and delayed surgery was defined as surgery after 72 hours. Outcomes were assessed by modified Rankin score. The mean time of follow-up was 12.5 ± 3.4 months. RESULTS: Of the 118 patients included in the study, 80 (68%) underwent early surgery and 38 (32%) underwent delayed surgery. Patients with brain herniation (P &lt; .001) and a lower Fisher grade (P = .02) more often underwent early surgery. Patients in the early group more often underwent decompressive craniectomy (P &lt; .001). Postoperative complications and length of hospital stay did not differ, and outcomes were similar between the 2 groups. Forty (34%) patients had an excellent outcome (modified Rankin score 0-1). Multivariate analysis showed a slight trend toward an excellent outcome in the early surgery group. Younger age, World Federation of Neurosurgical Societies grade IV after resuscitation, and middle cerebral artery aneurysms were independent predictors of an excellent outcome. CONCLUSION: Although patients with brain herniation and a lower Fisher grade were more likely to undergo early surgery, there was a slight trend toward an excellent outcome in the early surgery group. Patients with a younger age, World Federation of Neurosurgical Societies grade IV after resuscitation, and middle cerebral artery aneurysms were more likely to experience an excellent outcome.

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