Results and complications of surgical management of 809 intracranial aneurysms in 722 cases

1982 ◽  
Vol 56 (6) ◽  
pp. 753-765 ◽  
Author(s):  
Thoralf M. Sundt ◽  
Shigeaki Kobayashi ◽  
Nicolee C. Fode ◽  
Jack P. Whisnant
Keyword(s):  
Hospital Admission ◽  
Surgical Management ◽  
Intracranial Aneurysms ◽  
Intraoperative Complications ◽  
Aminocaproic Acid ◽  
Morbidity And Mortality ◽  
Early Surgery ◽  
Lower Grade ◽  
Operative Morbidity ◽  
Content Type

✓ Data from 722 consecutive cases with intracranial aneurysms were stored in a computer and later retrieved for analysis. Results and complications (including preoperative death and morbidity) of the surgical management of these patients were correlated with the Botterell grade of the patient in individuals with a recent subarachnoid hemorrhage (SAH), with the type of aneurysm, and with the timing of the surgical procedure. Patients with no SAH within 30 days prior to hospital admission were classified as “no SAH.” Approximately 30% of all patients had sustained more than one hemorrhage. Death and morbidity rates prior to surgery in good-grade patients with a recent SAH exceeded the risk of surgery itself. Rebleeding was the primary cause for death and morbidity in Grade 1 patients: 3% of Grade 1 patients died from a recurrent hemorrhage and 7% deteriorated to a lower grade. Deterioration from ischemia produced by vasospasm related or unrelated to rebleeding exceeded the risks of rebleeding in Grade 2 patients. There was an operative morbidity of 2% and mortality of 2% in patients who were classified as Grade 1 at the time of surgery, but an overall management morbidity of 3% and mortality of 6% in patients who were in Grade 1 at the time of hospital admission. Early surgery in Grade 1 patients was not associated with an increased incidence of delayed ischemia postoperatively. In Grade 2 patients, the operative morbidity and mortality was 7% and 4%, respectively, and the management morbidity and mortality 16% and 11%, respectively. Early surgery in this group was associated with a high frequency of postoperative delayed ischemia (particularly in patients with more than one SAH). Epsilon-aminocaproic acid appeared to protect against a rebleed, but was associated with a higher incidence of postoperative pulmonary emboli. Intraoperative complications were related both to the size of the aneurysm and to its location. Repair of multiple aneurysms did not adversely affect the result. The surgical approach, the importance of using a self-retaining brain retractor, and the technical complications in these cases are discussed.

Ruptured intracranial aneurysms

1977 ◽  
Vol 46 (3) ◽  
pp. 290-295 ◽  
Author(s):  
Kalmon D. Post ◽  
Eugene S. Flamm ◽  
Albert Goodgold ◽  
Joseph Ransohoff
Keyword(s):  
Blood Pressure ◽  
Intracranial Aneurysms ◽  
Bed Rest ◽  
Aminocaproic Acid ◽  
Morbidity And Mortality ◽  
Neurological Deficits ◽  
Surgical Mortality ◽  
Term Survival ◽  
Content Type ◽  
Ruptured Intracranial Aneurysms

✓ The authors review 100 consecutive cases of ruptured intracranial aneurysms to assess the overall morbidity and mortality. Patients were placed on a regimen of bed rest, sedation, control of blood pressure, anticonvulsants, and antifibrinolytic therapy. Surgery was performed on 86 patients with hypotensive anesthesia and microsurgical techniques. The incidence of early rebleeding while on epsilon aminocaproic acid and control of blood pressure was 11.8%. The overall surgical mortality was 8.1%, and the surgical mortality of patients in Grades 1, 2, and 3 was 6.3%. Of the 100 patients, 60 were able to return to their prior activities, and 25 had moderate neurological deficits that required limitation of their activities. The total case mortality was 15%. The evidence presented indicates that the regimen of active medical treatment before microsurgical intervention has improved the overall case morbidity and mortality, as well as the chance for long-term survival.

A method for monitoring antifibrinolytic therapy in patients with ruptured intracranial aneurysms

1981 ◽  
Vol 54 (1) ◽  
pp. 12-15 ◽  
Author(s):  
Kim J. Burchiel ◽  
Gottfried Schmer
Keyword(s):  
Fibrinolytic Activity ◽  
Intracranial Aneurysms ◽  
Aminocaproic Acid ◽  
Content Type ◽  
Antifibrinolytic Therapy ◽  
Epsilon Aminocaproic Acid ◽  
Ruptured Intracranial Aneurysms ◽  
Control Plasma ◽  
Fine Print

✓ A rapid fluorometric assay technique has been utilized to assess the degree of fibrinolytic inhibition in 20 patients with ruptured intracranial aneurysms treated with epsilon-aminocaproic acid (EACA). This method quantitates the available plasminogen activity (APA) of plasma, and has proven to be a reliable means of monitoring antifibrinolytic therapy. Determination of the plasma APA also permits correlation of the level of fibrinolytic activity with putative complications of EACA therapy. Normal control plasma APA was 3.1 ± 0.7 CTA units/ml, but in patients with subarachnoid hemorrhage (SAH), pretreatment fibrinolytic activity was supranormal at 3.78 ± 0.88 CTA units/ml. During continuous intravenous administration of EACA (1.5 gm/hr) in patients with SAH, the plasma fibrinolytic activity was decreased to 0.9 ± 0.31 CTA units/ml. A case is described which exemplifies the use of this assay. In addition, an approach to monitoring antifibrinolytic therapy using the plasma APA is proposed.

Epsilon-aminocaproic acid and recurrent subarachnoid hemorrhage

1980 ◽  
Vol 53 (1) ◽  
pp. 28-31 ◽  
Author(s):  
William A. Shucart ◽  
S. K. Hussain ◽  
Paul R. Cooper
Keyword(s):  
Clinical Trial ◽  
Intracranial Aneurysms ◽  
Aminocaproic Acid ◽  
Antifibrinolytic Agents ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Epsilon Aminocaproic Acid ◽  
Arterial Aneurysms ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

✓ A clinical trial of epsilon-aminocaproic acid (EACA) in preventing recurrent hemorrhage from intracranial arterial aneurysms is reported. Previous reports were reviewed, and their results concerning antifibrinolytic agents were inconclusive in establishing their efficacy. One hundred patients with documented ruptured intracranial aneurysms were admitted to this study within 48 hours of the initial hemorrhage: 45 patients received 36 gm of EACA/day, with 11 documented rebleeds and one suspected rebleed; 55 patients did not receive EACA, and there were four documented rebleeds and one suspected rebleed. No benefit was seen from the use of EACA.

Surgical management of unruptured intracranial aneurysms

1994 ◽  
Vol 80 (3) ◽  
pp. 440-446 ◽  
Author(s):  
Robert A. Solomon ◽  
Matthew E. Fink ◽  
John Pile-Spellman
Keyword(s):  
Surgical Management ◽  
Intracranial Aneurysms ◽  
Clinical Decision Making ◽  
Mass Effect ◽  
Endovascular Embolization ◽  
Surgical Morbidity ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Fine Print

✓ The surgical management of patients with unruptured intracranial aneurysms continues to be controversial. The criteria for withholding treatment or choosing between endovascular embolization and conventional microsurgery are not well delineated. The present study analyzes the morbidity and mortality that can be expected with modern surgical management of unruptured aneurysms, and therefore serves as a point of reference for clinical decision-making in this group of patients. A total of 202 consecutive operations for attempted clipping of unruptured intracranial aneurysms are reported. Subarachnoid hemorrhage from another aneurysm was the most common presentation (55 cases). Thirty-seven patients presented with headache, 36 with mass effect from the aneurysm, and 19 with embolic events; 11 aneurysms were associated with an arteriovenous malformation, 10 caused seizures, and 34 were incidental findings. Excellent or good outcome was achieved in 100% of patients with aneurysms less than 10 mm in diameter, 95% with aneurysms 11 to 25 mm, and 79% with aneurysms greater than 25 mm. Except for giant basilar aneurysms, size (and not location) of the aneurysm was the key predictor of risk for surgical morbidity. These data may be useful when discussing with patients the risk:benefit ratio of choosing between conservative management, endovascular embolization, and microsurgical clipping.

A proposed scheme for grading intracranial arteriovenous malformations

1986 ◽  
Vol 65 (4) ◽  
pp. 484-489 ◽  
Author(s):  
Yu-quan Shi ◽  
Xian-cheng Chen
Keyword(s):  
Arteriovenous Malformations ◽  
Surgical Excision ◽  
Venous Drainage ◽  
Morbidity And Mortality ◽  
Intracranial Arteriovenous Malformations ◽  
Surgical Morbidity ◽  
Operative Morbidity ◽  
Content Type ◽  
Grade Classification ◽  
Grading Scale

✓ A four-grade classification scheme for intracranial arteriovenous malformations (AVM's) is proposed. Grading is based on 1) the size of the AVM; 2) its location and depth; 3) its arterial supply; and 4) its venous drainage. Each of these aspects is divided into four grades with respect to the difficulty it poses for surgical excision. A description of the grading system and its application is given. This grading scale has been correlated with the operative morbidity and mortality in 100 cases of excised intracranial AVM's. The results show that the higher the grade of AVM, the greater the risk of surgical morbidity and mortality. This grading scale is simple and easy to apply. It can guide neurosurgeons in selecting AVM patients suitable for operation, in determining the best type of operation to perform, and in predicting operative difficulties as well as postoperative results.

Surgical management of diastatic linear skull fractures in infants

1973 ◽  
Vol 39 (4) ◽  
pp. 493-497 ◽  
Author(s):  
John B. Thompson ◽  
Thomas H. Mason ◽  
Gerald L. Haines ◽  
Robert J. Cassidy
Keyword(s):  
Brain Tissue ◽  
Surgical Management ◽  
Clinical Findings ◽  
Long Term Results ◽  
Early Surgery ◽  
Skull Fractures ◽  
Content Type ◽  
Subgaleal Space ◽  
Fine Print

✓ In seven infants, nondepressed diastatic linear skull fractures occurred with extrusion of brain tissue into the subgaleal space. These patients exhibited a triad of clinical findings that should encourage early surgery. Craniotomy and duroplasty seem to offer the most satisfactory long-term results.

The International Cooperative Study on the Timing of Aneurysm Surgery

1990 ◽  
Vol 73 (1) ◽  
pp. 37-47 ◽  
Author(s):  
Neal F. Kassell ◽  
James C. Torner ◽  
John A. Jane ◽  
E. Clarke Haley ◽  
Harold P. Adams ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Intracranial Aneurysms ◽  
Early Surgery ◽  
Surgical Results ◽  
Aneurysm Surgery ◽  
Cooperative Study ◽  
Content Type ◽  
Delayed Surgery ◽  
Postoperative Risk ◽  
Ruptured Intracranial Aneurysms

✓ A prospective, observational clinical trial was conducted by the International Cooperative Study on the Timing of Aneurysm Surgery to determine the best time in relation to the hemorrhage for surgical treatment of ruptured intracranial aneurysms. Sixty-eight centers contributed 3521 patients in a 2½-year period beginning in December, 1980. Analysis by a prespecified “planned” surgery interval demonstrated that there was no difference in early (0 to 3 days after the bleed) or late surgery (11 to 14 days). Outcome was worse if surgery was performed in the 7 to 10-day post-bleed interval. Surgical results were better for patients operated on after 10 days. Patients alert on admission fared best; however, alert patients had a mortality rate of 10% to 12% when undergoing surgery prior to Day 11 compared with 3% to 5% when surgery was performed after Day 10. Patients drowsy on admission had a 21% to 25% mortality rate when operated on up to Day 11 and 7% to 10% with surgery thereafter. Overall, early surgery was neither more hazardous nor beneficial than delayed surgery. The postoperative risk following early surgery is equivalent to the risk of rebleeding and vasospasm in patients waiting for delayed surgery.

Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: a meta-analysis

1994 ◽  
Vol 81 (6) ◽  
pp. 837-842 ◽  
Author(s):  
Joseph T. King ◽  
Jesse A. Berlin ◽  
Eugene S. Flamm
Keyword(s):  
Confidence Interval ◽  
Intracranial Aneurysms ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Content Type ◽  
Unruptured Intracranial Aneurysms ◽  
The Impact ◽  
Fine Print

✓ A meta-analysis of the literature on morbidity and mortality from elective surgery for asymptomatic unruptured intracranial aneurysms was performed to obtain a more precise, accurate, and generalizable estimate of operative risk than is currently available. The authors used a MEDLINE search from 1966 to 1992, supplemented with manual searches, to locate studies containing four or more patients who had undergone elective surgery for these aneurysms. Only patients with asymptomatic, unruptured aneurysms were eligible for inclusion. Demographic and clinical data were collected from each series; aneurysms were categorized as incidental, multiple, or unclassifiable. Data were analyzed using Fisher's exact test and logistical regression. There were twenty-eight articles containing data on 733 patients who met eligibility criteria. The mean patient age was 48.6 ± 5.5 years, and 55% ± 17% of the patients were women. There was a total of 30 deficits for a morbidity rate of 4.1% (95% confidence interval 2.8, 5.8%) and a total of seven deaths for a mortality rate of 1.0% (95% confidence interval 0.4, 2.0%). There was insufficient statistical power to detect a difference in morbidity or mortality rates related to study size, year of publication, or potential risk factors such as patient sex or age, or aneurysm size, location, or category (incidental, multiple, or unclassifiable) (for all analyses, p ≥ 0.16). Elective surgery for asymptomatic unruptured intracranial aneurysms, as reported in the literature, has low rates of morbidity (4.1%) and mortality (1.0%). At present there is insufficient detail in the literature to understand the impact of patient and aneurysm characteristics on elective surgical outcomes.

Use of epsilon aminocaproic acid (EACA) in the preoperative management of ruptured intracranial aneurysms

1976 ◽  
Vol 44 (4) ◽  
pp. 479-484 ◽  
Author(s):  
Ram P. Sengupta ◽  
Sing C. So ◽  
Francisco J. Villarejo-Ortega
Keyword(s):  
Intracranial Aneurysms ◽  
Aminocaproic Acid ◽  
Preoperative Period ◽  
Preoperative Management ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Antifibrinolytic Therapy ◽  
Similar Series ◽  
Epsilon Aminocaproic Acid ◽  
Ruptured Intracranial Aneurysms

✓ The authors report their experience with the use of epsilon aminocaproic acid (EACA) in the preoperative management of a series of patients with ruptured intracranial aneurysms. A similar series of patients was taken as control. They found that EACA is of definite value in preventing recurrent hemorrhage in the preoperative period. The significance of antifibrinolytic therapy in ruptured intracranial aneurysms is discussed.

One-Year Morbidity and Mortality Rates Associated with Clipping Unruptured Intracranial Aneurysms

2019 ◽  
Author(s):  
Khodayar Goshtasbi ◽  
Ronald Sahyouni ◽  
Alice Wang ◽  
Edward Choi ◽  
Gilbert Cadena ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Unruptured Intracranial Aneurysms ◽  
One Year
Sign in / Sign up

Export Citation Format

Share Document