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  • 1
    Electronic Resource
    Electronic Resource
    Early aneurysm surgery: a 7 year clinical practice report (1988)
    Springer
    Acta neurochirurgica 90 (1988), S. 91-102 
    Details
    ISSN: 0942-0940
    Keywords: Ruptured aneurysm ; early surgery ; pre- and postoperative management ; morbidity ; mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary One hundred and fifty patients with intracranial aneurysms, operated on consecutively in the early stage in our department, were re-evaluated retrospectively. Seven surgeons operated on 159 aneurysms in 150 patients. Seventy-nine percent of the patients were in grades I–III (scale of Hunt and Hess), 21% in grades IV–V. Seventyone percent had a severe haemorrhage (classification of Fisheret al.), 21% had an intracerebral haematoma. Intraoperative CSF drainage was an almost indispensable tool while postoperative external drainage did not prove to be helpful in preventing vasospasm and/or hydrocephalus. Induced hypotension was abandoned in favour of temporary clipping. Thirteen percent of the patients suffered a permanent or fatal immediate postoperative deterioration, while 11% developed delayed neurological deficits. Five percent were related to vasospasms alone, they were all transient. Five percent had vasospasm combined with other complications. One of them had permanent and the other one fatal deficits. One percent deteriorated due to embolism or occluded vessels. The results improved with the introduction of the calcium channel blocker nimodipine, induced hypertension and transcranial Doppler sonographic control of the vasospasm. Patients in good preoperative condition had a good early outcome in 69%. The result was fair in 21% and poor in 4%, while 6% of the patients died. In the poor condition group 22% of the patients made a good, 13% a fair, and 59% a poor recovery, 16% of whom died. We conclude that today the results of early surgery are becoming similar to those of delayed surgery and that the importance of vasospasm for an unfavourable outcome is insignificant in comparison with lesions produced by the haemorrhage and operation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01560561
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Morbidity and mortality after early aneurysm surgery — a prospective study with nimodipine prevention (1989)
    Springer
    Acta neurochirurgica 96 (1989), S. 1-7 
    Details
    ISSN: 0942-0940
    Keywords: Early aneurysm surgery ; morbidity ; mortality ; vasospasm ; nimodipine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Based on the outcome in 116 consecutive patients who were subjected to early aneurysm operation combined with additional nimodipine treatment, and who were controlled by transcranial Doppler (TCD) sonography, a morbidity and mortality analysis was performed. Of the 84 patients who preoperatively were in Hunt & Hess grades III, 79 patients (94%) were considered to show a favourable (good-fair) late recovery, while one patient (1%) had a poor outcome, and four patients (5%) died. Of the 32 poor condition patients (H & H IV–V), 17 (53%) showed a favourable recovery, while seven (22%) had a poor outcome, and eight patients (25%) died. Altogether, 20 patients (17%) had an unfavourable (poor-dead) outcome. Only two of these patients showed delayed ischaemic deterioration, one as a consequence of a secondary occlusion of perforating branches from the basilar artery and one with decompensated vasospasm after the evacuation of an epidural haematoma and a longlasting severe systemic hypotension; both these patients died. In another six of the patients with an unfavourable outcome, this was mainly related to a complicated surgery. The unfavourable outcome was related to primary brain damage produced by the subarachnoid haemorrhage (SAH) in ten patients and in two patients to internal medical complications. In addition to the two patients who died following delayed deterioration, secondary neurological dysfunction occurred in 11 patients. In 10 of these patients transient neurological dysfunction was attributed to vasospasm or to a combination of vasospasm with intraoperative or postoperative complications. One further case of delayed deterioration was attributed to secondary occlusion of the internal carotid artery after a complicated operation. From these data we conclude that following early aneurysm operation combined with intravenous nimodipine treatment, vasospasm alone is no more a major clinical problem. Morbidity and mortality are mainly related to primary effects of the SAH and/or complicated surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01403488
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
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