A long-term follow-up study in direct cerebral aneurysm surgery

Kamitani, Hiroshi; Masuzawa, Hideaki; Kanazawa, Itaru; Kubo, Tetsuo; Tokuyama, Yoshiaki

doi:10.1007/bf01420063

Cited by 7 publications

(3 citation statements)

References 21 publications

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“…However, the occurrence of SAH during the late postoperative period 6 , with an unfavorable course 3 -4 ' 914 , has led to a rethinking of this concept and to the proposal of measures that will minimize this risk.…”

Section: Discussionmentioning

confidence: 99%

Subarachnoid hemorrhage after aneurysm surgery

Carlotti¹,

Martelli²,

Assirati³

et al. 1996

Arq. Neuro-Psiquiatr.

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-The surgical treatment of intracranial aneurysms by clipping is recognized as effective and definitive. However some cases that suffered a new subarachnoid hemorrhage (SAH) some time after they were submitted to aneurysm clipping have raised doubts about the concept of "cure"after this treatment. Eleven patients previously submitted to aneurysm clipping who presented a new SAH were analyzed. The time elapsed from surgery to SAH varied from 3 to 10 years. After SAH four patients had a poor outcome. The new episode of SAH occurred due to intrinsic factors of the cerebral vasculature: 1. a weak point of the vessel wall near the previous aneurysm, 2. a weak point of another vessel far from the previous aneurysm, 3. a previous infundibular dilation of the posterior communicating artery; and due to technical problems: 1. aneurysm not identified during the previous treatment, 2. aneurysm deliberately left untreated, 3. persistence of the aneurysm due to inappropriate surgery, 4. persistency of part of the aneurysm neck after clipping and 5. slipping of the clip from the neck of the aneurysm. The measures to prevent new SAH after surgery start with adequate preoperative angiographic studies, a careful inspection of the position of the clip and emptying of the aneurysm. Early angiography studies may reveal a persistent neck and later ones may reveal newly developed aneurysms. In conclusion, SAH after aneurysm clipping is a late and severe phenomenon and the concept of "cure" after this surgery should be interpreted with caution. KEY-WORDS: recurrent subarachnoid hemorrhage, ruptured cerebral aneurysms, surgical treatment.Hemorragia subaracnóide após cirurgia de aneurisma RESUMO -O tratamento cirúrgico dos aneurismas cerebrais através de sua clipagem é reconhecido como eficaz e definitivo. Entretanto alguns casos sofrem nova hemorragia algum tempo após a cirurgia, deixando dúvidas sobre a "cura" pelo tratamento. Onze pacientes submetidos anteriormente a clipagem do aneurisma e que apresentaram nova hemorragia foram analisados. O intervalo de tempo da cirurgia para a nova hemorragia foi de 3 a 10 anos. Após a nova hemorragia, 4 pacientes tiveram evolução desfavorável. O novo episódio de hemorragia subaracnóide ocorreu devido a fatores intrínsicos dos vasos cerebrais ou a problemas técnicos. Dentre os fatores intrínsicos temos: l.um ponto fraco da parede do vaso próximo ao aneurisma, 2. um ponto fraco em outro vaso longe do aneurisma, 3. dilataçâo infundibular já existente próximo a artéria comunicante posterior. Devido a problemas técnicos encontramos: 1. aneurismas não identificados no tratamento anterior, 2. aneurisma deliberadamente não tratado, 3. persistência do aneurisma por cirurgia inapropriada, 4. persistência de parte do colo do aneurisma após a cirurgia, S. escorregamento do clip. As medidas para prevenir a nova hemorragia subaracnóide iniciam-se no estudo angiográfico pré-operatório, inspeção cuidadosa da posição do clip e no esvaziamento do aneurisma. A angiografia precoce pode revelar a persistência...

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Section: Discussionmentioning

confidence: 99%

Subarachnoid hemorrhage after aneurysm surgery

Carlotti¹,

Martelli²,

Assirati³

et al. 1996

Arq. Neuro-Psiquiatr.

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“…Obwohl die chirurgischen Ergebnisse nach Aneurysmawrapping bezüglich einer Nachblutung in der Literatur kontrovers diskutiert werden, ist das Verfahren verlassen worden. (16,26,28,36,38,41 (58), wobei wesentlicher und häufiger Kritikpunkt an dieser Arbeit ist, dass die Aussagen ausschließlich auf der Verwendung von aktuell nicht mehr zugelassenen bzw. vom Markt genommenen Produkten fußt.…”

Section: Behandlungsmöglichkeiten Für Aneurysmen Chirurgische Behandlunclassified

Die spontane Subarachnoidalblutung

Dorn¹,

Liebig²,

Rothoerl³

2008

Nervenheilkunde

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ZusammenfassungHäufigste Ursache einer nicht traumatischen Subarachnoidalblutung (SAB) ist mit etwa 85% die Ruptur eines Aneurysmas der Hirnbasisarterien. Der plötzlich einsetzende heftige Kopfschmerz (,,Vernichtungskopfschmerz“) ist das Leitsymptom der spontanen SAB. Bei klinischem Verdacht auf eine SAB wird meist eine zerebrale Computertomografie (CCT) veranlasst, in der das subarachnoidale Blut hyperdens in den Liquorräumen zur Darstellung kommt. Nach wie vor gilt die digitale Subtraktionsangiografie (DSA) als Goldstandard beim Nachweis zerebraler Aneurysmen. Sie liefert neben der Aneurysmalokalisation wichtige Informationen bezüglich der Aneurysmakonfiguration und der Lagebeziehung zu angrenzenden Gefäßen, welche die Auswahl des therapeutischen Verfahrens (Coiling oder OP) entscheidend beeinflussen. In der subakuten Phase ist der Patient durch ein verzögert einsetzendes neurologisches Defizit (Vasospasmus), eine Nachblutung oder einen Hydrozephalus gefährdet. Zur Versorgung der Blutungsquelle stehen operative wie auch endovaskuläre Verfahren zur Verfügung. Trotz der Fortschritte in Diagnostik und Therapie ist die Prognose einer aneurysmatischen Subarachnoidalblutung ernst.

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“…Outcome parameters (Table 1) were collected and assessed for the respective treatment of each aneurysm whenever possible. 4,8,13,[15][16][17]23,25,28,39,41,46,47,[51][52][53]57,59,70,73,75,80,81,85,87,89,91,93,96,99 These included the extent of aneurysm obliteration (as earlier defined), postprocedure incidences of mortality, brain infarcts documented on CT scans (asymptomatic as well as those accompanied by minor or major symptoms), and the GOS scores assigned at discharge from the hospital and at 6 months posttreatment. For each clinical encounter (as defined earlier) we also assessed hospital and ICU LOS, and inflation-adjusted hospital charges as an index of cost of care and resource utilization.…”

Section: Data Collectionmentioning

confidence: 99%