Surgical Treatment of Seriously Ill Cases with Ruptured Cerebral Aneurysm in Acute Stage

It is apparent that subarachnoid clots play an important role in the development of delayed vasospasm that is one of the major causes of mortality and morbidity in patients with acutely ruptured cerebral aneurysm. The purpose of this study is to compare the clearance of subarachnoid clots in the acute stage after the treatment with Guglielmi detachable coils (GDC) and after treatment with direct surgery. Forty-nine patients were treated by GDC embolization within four days of the ictus. After GDC embolization, adjunctive therapies, such as ventricular and/or spinal drainage (67%), intrathecal administration of urokinase (41%), continuous cisternal irrigation (16%), and external decompression (16%), were performed. Seventy-four surgically treated patients were subsequently treated by continuous cisternal irrigation with mock-CSF containing ascorbic acid for ten days. The clearance of subarachnoid clots was assessed by the Hounsfield number serial changes on the CT scans taken on days 0, 4, 7, 10 after subarachnoid hemorrhage. The incidence of symptomatic vasospasm was lower in the GDC group (6%) than in the surgery group (12%). The clearance of subarachnoid clots from both the basal cistern and the Sylvian fissure was more rapid in the GDC cases than in the surgery cases in the first four days. Intrathecal administration of urokinase accelerated the clearance significantly. GDC embolization followed by intrathecal administration of thrombolytic agents accelerates the reduction of subarachnoid clots and favorably acts to prevent delayed vasospasm.

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Angiographical Change of Guglielmi Detachable Coils

Interventional Neuroradiology ◽

10.1177/15910199040100s128 ◽

2004 ◽

Vol 10 (1_suppl) ◽

pp. 161-166 ◽

Cited By ~ 2

Author(s):

Y. Nakai ◽

M. Sonobe ◽

T. Takigawa ◽

T. Yamazaki ◽

S. Okamoto ◽

...

Keyword(s):

Cerebral Aneurysm ◽

Medical Condition ◽

Cerebral Aneurysms ◽

Acute Stage ◽

Guglielmi Detachable Coils ◽

Unruptured Aneurysms ◽

Detachable Coils

Acute angiographical changes for preventing acute rebleeding on GDC treated cerebral aneurysms were evaluated. From December 2000 to November 2002, 48 total aneurysms in 44 consecutive patients with acute SAH. Acute angiographical evaluations were carried out in 46 aneurysms, including 42 ruptured and 4 unruptured aneurysms. Two cases were excluded because of poor medical condition. In this series, there were no rebleeding cases in acute stage. In the initial embolization for the 46 aneurysms, CO was achieved in eight aneurysms, NR in 15 aneurysms and BF in 23 aneurysms. Acute angiographical observations showed progressive thrombosis in 17 aneurysms (37%). No changes were observed in remaining 29. No recanalization was observed in this series. Only one case of BF, inside the aneurysm bleb was still observed during follow up. Additional embolization was carried out. Progressive thrombosis was frequently observed in GDC treated cerebral aneurysms during acute stage. This angiographical finding seems to show prevention of rebleeding, which is considered important for the management of GDC treatment in acutely ruptured cerebral aneurysm.

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Cerebral arterial aneurysm formation and rupture in 20,767 elderly patients: hypertension and other risk factors

Journal of Neurosurgery ◽

10.3171/jns.1995.83.5.0812 ◽

1995 ◽

Vol 83 (5) ◽

pp. 812-819 ◽

Cited By ~ 124

Author(s):

Christopher L. Taylor ◽

Zhong Yuan ◽

Warren R. Selman ◽

Robert A. Ratcheson ◽

Alfred A. Rimm

Keyword(s):

Surgical Treatment ◽

Elderly Patients ◽

Cerebral Aneurysm ◽

Primary Diagnosis ◽

Content Type ◽

Unruptured Aneurysms ◽

Aneurysm Formation ◽

Unruptured Cerebral Aneurysm ◽

Significant Protective Effect ◽

Fine Print

✓ Cerebral arterial aneurysms are common in the general population and their rupture is a catastrophic event. Considerable uncertainty remains concerning the conditions that predispose individuals to aneurysm formation or rupture. The role of systemic hypertension in aneurysm formation and rupture has been especially controversial. Demographic variables have rarely been addressed because of the small sample sizes in previous studies. The authors describe the demographics and prevalence of hypertension in 20,767 Medicare patients with an unruptured aneurysm and compare these to a random sample of the hospitalized Medicare population. The prevalence of hypertension in patients with unruptured aneurysms was 43.2% compared with 34.4% in the random sample. Patients who survived their initial hospitalization were separated into two groups: those with an unruptured cerebral aneurysm as the primary diagnosis and those with an unruptured cerebral aneurysm as a secondary diagnosis. Follow-up data for 18,119 patients were examined to determine the risk of subarachnoid hemorrhage (SAH) associated with age, gender, race, hypertension, insulin-dependent diabetes mellitus, and surgical treatment. For patients with an unruptured cerebral aneurysm as the primary diagnosis, hypertension was found to be a significant risk factor for future SAH (risk ratio: 1.46, 95% confidence interval (CI): 1.01–2.11), whereas surgical treatment (risk ratio: 0.29, 95% CI: 0.09–0.97) had a significant protective effect. Advancing age had a small but significant protective effect in both groups. Elderly patients identified with unruptured aneurysms are more likely to have coexisting hypertension than the general hospitalized population. In elderly patients hospitalized with an unruptured cerebral aneurysm as their primary diagnosis, hypertension is a risk factor for subsequent SAH, whereas surgical treatment is a protective factor against SAH.

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Feodor Lynen, 6 April 1911 - 6 August 1979

Biographical Memoirs of Fellows of the Royal Society ◽

10.1098/rsbm.1982.0012 ◽

1982 ◽

Vol 28 ◽

pp. 261-317 ◽

Cited By ~ 2

Keyword(s):

Surgical Treatment ◽

Abdominal Aorta ◽

Postgraduate Students ◽

The World ◽

Dupuytren Contracture ◽

A Minor ◽

Seriously Ill

Feodor Lynen died on 6 August 1979 of complications following an operation six weeks before for the repair of an aneurism of the abdominal aorta. Until then he had been fit. The aneurism, of which he had had no symptoms, had come to light when Lynen had been in hospital for a minor operation on his hand, treatment of a Dupuytren contracture, and a general medical check before the planned operation revealed the possibility of an aneurism. A specialist confirmed the diagnosis and suggested surgical treatment. Lynen accepted the advice without hesitation because one of his elder brothers had died of a ruptured aneurism a few years earlier. Lynen’s operation took place on 25 June and was at first thought to have been successful, but complications developed and he became seriously ill. Lynen was one of the outstanding biochemists of his generation and made many highly original discoveries. His intellectual brilliance was combined with an exceptionally attractive, warm-hearted and open personality and with a tremendous zest for life. Students at all levels (especially postgraduate students) and from all over the world, flocked to his laboratory, which became one of the great international centres of biochemistry.

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