Aneurysm surgery of patients in poor grade condition. Indications and experience

Ungersböck, K.; Böcher-Schwarz, H. G.; Ulrich, P.; Wild, Aaron T.; Perneczky, Axel

doi:10.1080/01616412.1994.11740188

Cited by 36 publications

(19 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…They reported the results of 35 grade IV and V patients chosen for active treatment with a mortality rate of 23% and a good outcome in 54%. Following this report, other groups have reported similar outcomes of poor grade patients The CT scan findings were used to determine the proposed mechanism of coma andto direct subsequent treatment [44,53,64]. These improved outcomes were obtained by combing early surgery with intensive medical management of vasospasm and elevated ICR The follow-up of this group of patients seemed to indicate that early surgery in poor grade patients did nor result in a greater number of poor outcomes but rather, increased the overall number of good survivors.…”

Section: Introductionmentioning

confidence: 98%

Patients in poor neurological condition after subarachnoid hemorrhage: Early management and long-term outcome

Rordorf

Ogilvy²,

Gress

et al. 1997

Acta neurochir

View full text Add to dashboard Cite

We report management and outcome data on 118 patients that presented to our emergency room over a 4 year interval (1990-1994) in poor neurological condition after subarachnoid hemorrhage. All patients were treated following a strict protocol. After initial evaluation, patients underwent a head computerized tomography (CT) scan to try to understand the mechanism of coma. If CT did not show destruction of vital brain areas, a ventriculostomy was inserted and ICP measured. If ICP was less than 20 mm Hg, or if standard treatment of increased ICP was able to lower the ICP to a value less than 20 mmHg, patients were evaluated with cerebral angiogram to determine the location of the ruptured aneurysm. The lesion was then treated by craniotomy for aneurysm clipping or endovascular obliteration. Postoperative monitoring for vasospasm with clinical exam and transcranial doppler studies was performed routinely. If vasospasm developed, this was managed aggressively with hypertensive, hypervolemic and hemodilutional therapy and, at times, endovascular treatment with angioplasty or papaverine. Outcome was measured at 1 year or more after treatment. Among patients who met criteria for aneurysm treatment, 47% had excellent or good neurologic outcome. There was a 30% mortality rate in these patients. In patients with high ICP, poor brainstem function or destruction of vital brain areas on CT, comfort measures only were offered and almost all died. It is concluded that an approach of early aneurysm obliteration and aggressive medical and endovascular management of vasospasm is warranted in patients in poor neurological conditions after subarachnoid hemorrhage.

show abstract

Section: Introductionmentioning

confidence: 98%

Patients in poor neurological condition after subarachnoid hemorrhage: Early management and long-term outcome

Rordorf

Ogilvy²,

Gress

et al. 1997

Acta neurochir

View full text Add to dashboard Cite

show abstract

“…Использование подобной практики, несо-мненно, снижает частоту неблагоприятных функ-циональных исходов вследствие повторных крово-течений из аневризм у неоперированных больных [9,12,13,16,[19][20][21].…”

Section: Discussionunclassified

“…Тем не менее за последние четверть века, про-шедших с момента окончания «The International Cooperative Study on the Timing of Aneurysm Surgery», наиболее активными нейрохирургическими центра-ми был накоплен значительный опыт по лечению больных с АВК в различные временные интервалы острого периода, в том числе у пациентов, поступа-ющих в декомпенсированном состоянии [9,12,13,16,[19][20][21].…”

Section: Discussionunclassified

“…В ряде работ [9,12,13,[19][20][21] и др. показано, что раннее хирургическое лечение пациентов, по-ступающих в декомпенсированном состоянии (IV-V степень по шкале H-H), позволяет добиваться значительно лучших показателей общей и после-операционной летальности по сравнению с резуль-татами проведенных ранее кооперативных исследо-ваний.…”

Section: Discussionunclassified

See 1 more Smart Citation

The use of transcallosal ventriculostomy to treat complicated forms of aneurismal intracranial hemorrhages

2015

Vopr. neirokhir.

View full text Add to dashboard Cite

Ранние микрохирургические вмешательства в остром периоде аневризматического внутричереп-ного кровоизлияния (АВК) традиционно относят к операциям повышенного хирургического риска.Техническая сложность таких операций много-кратно возрастает при наличии у пациента ослож-ненных форм АВК: гемотампонады базальных ци-стерн, массивного внутримозгового и/или внутри-желудочкового кровоизлияния [4]. У данного кон-тингента больных оперирующий хирург нередко сталкивается с ситуацией, когда проведенные ане-стезиологом мероприятия по созданию «мягкого мозга» [15] оказываются недостаточными и напря-жение вещества мозга остается значительным. В этих случаях для успешного проведения основного этапа операции необходимо добиться релаксации вещества мозга хирургическими методами [6].В основе релаксации мозга лежит возможность посредством оперативных приемов осуществить «внутреннюю декомпрессию мозга» путем аспира-ции ликвора и кровяных сгустков из «резервных внутричерепных пространств» [2].Одним из наиболее эффективных, но техниче-ски сложных способов релаксации мозга является

show abstract

“…Moreover, bultra-earlyQ surgery is often recommended because a major risk of rebleeding after SAH is present within the first 6 to 12 hours, and the risk of ultra-early rebleeding is highest for poor-grade patients [15]. While early surgery decreases the risk of rehemorrhage, it is often questioned because of concerns related to increased risk of surgical complications and the infliction of further damage to the already edematous brain caused by retraction and manipulation of cerebral vessels [5,6,10,11,14,27,29].…”

Section: Introductionmentioning

confidence: 99%

One-stage embolization in patients with acutely ruptured poor-grade aneurysm

Shin¹,

Kim

Kim³

et al. 2005

Surgical Neurology

View full text Add to dashboard Cite

Aneurysm surgery of patients in poor grade condition. Indications and experience

Cited by 36 publications

References 0 publications

Patients in poor neurological condition after subarachnoid hemorrhage: Early management and long-term outcome

Patients in poor neurological condition after subarachnoid hemorrhage: Early management and long-term outcome

The use of transcallosal ventriculostomy to treat complicated forms of aneurismal intracranial hemorrhages

One-stage embolization in patients with acutely ruptured poor-grade aneurysm

Contact Info

Product

Resources

About