Causes of neurological deficits following clipping of 200 consecutive ruptured aneurysms in patients with good-grade aneurysmal subarachnoid haemorrhage

Bulters, Diederik; Santarius, Thomas; Chia, Hui Ling; Parker, Richard; Trivedi, Rikin; Kirkpatrick, Peter J.; Kirollos, Ramez

doi:10.1007/s00701-010-0896-y

Cited by 27 publications

(26 citation statements)

References 25 publications

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“…Although according to an older study, 8 there was no correlation between the rank of the surgeon and the occurrence of POH after craniotomy, in a newer study, there was a lower rate of surgical complications (15.8% vs. 28.6%) and surgical vascular complications (7.6% vs. 16.7%) among high-volume (clipped >40 aneurysms per annum during the study period) compared with low-volume surgeons (<40 aneurysms), but this was statistically not significant. 62 However, patients operated on by high-volume surgeons were significantly less likely to have a new neurologic deficit on discharge (17.1% vs. 33.3%; P ¼ 0.03), so experience may play a role in such a low incidence of POH after unruptured aneurysm clippings in this series.…”

Section: Poh Incidence After Different Types Of Proceduresmentioning

confidence: 65%

Incidence of Postoperative Hematomas Requiring Surgical Treatment in Neurosurgery: A Retrospective Observational Study

et al. 2017

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Section: Poh Incidence After Different Types Of Proceduresmentioning

confidence: 65%

Incidence of Postoperative Hematomas Requiring Surgical Treatment in Neurosurgery: A Retrospective Observational Study

et al. 2017

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“…In a study analyzing 9488 aneurym surgeries, IOR occurred at a frequency of 10.09% in the pterional group and 5.78% in the suprabrow group, but considering the group of 3039 ruptured aneurysms, it occurred in 13.8% of the pterional group, and 19.37% of the suprabrow group [16]. In a study focusing only on ruptured aneurysms, IOR occurred in the pterional group at 6%-34.9%, and in the suprabrow group at 0-26% [11,[17][18][19][20][21][22][23][24][25][26]. In an analysis comparing the supraorbital keyhole approach (10.6%) and the pterional approach (2.5%) directly, the supraorbital group showed higher IOR frequency [8].…”

Section: Figure 4 (A and B)mentioning

confidence: 96%

A 16 Year Experience with Modified Lateral Supraorbital Approach for Ruptured Cerebral Aneurysms

Lim¹,

Cho²

2017

Arch Med

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Objectives: Upto now, most authors reported the supraorbital approach for unruptured aneurysm and small and less complex aneurysm. The authors devised the Modified Lateral Supraorbital (MLSO) approach. We present a 16 year experience with MLSO approach for ruptured anterior circulation aneurysms and some parts of posterior circulation aneurysms. Materials and Methods:Aneurysm clipping surgery through the MLSO approach was performed on a total 323 patients. Baseline demographics, operative time, procedural complications, and clinical outcomes at 6 months and 1 year were retrospectively analyzed.Results: For patients treated MLSO approach, 293 had single aneurysms and 30 had multiple aneurysms. The proportion of small, medium, large, and giant aneurysms were 64% (206/323), 31% (101/323), 4.7% (15/323), and 0.3% (1/323). Mean operation time was 219.6 minutes. Procedural complications occurred in 21 cases (6.5%). Five patients died from severe brain swelling and refusal of additional treatment, while 1 patient died from tonsilar herniation due to lumbar catheter drainage. Favorable clinical outcomes, Glasgow Outcome Scale IV or V, were observed in 82.6% (267/293) and 83.6% (270/293) at 6 months and one year follow-up.The MLSO approach has the following advantages: less brain retraction, good surgical field for high positioned A-com or basilar tip aneurysm surgery, short operation time, small skin incision, minimizing temporal muscle manipulation and good cosmetic appearance. Conclusions:The MLSO approach can be considered as a useful approach for neurosurgeons for cases of general ruptured aneurysm, except those with a large amount of intracerebral hemorrhage and severe brain swelling.

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“…41 Vascular surgeries requiring craniotomy, such as aneurysm clipping, carry the most risk in this subspecialty. Bulters et al 6 analyzed 200 patients who underwent surgical clipping and found a 19% complication rate, including direct brain injury, cranial nerve injury, postoperative hematoma, and ischemic events.…”

Section: Neurosurgical Checklistsmentioning

confidence: 99%

Neurosurgical checklists: a review

Zuckerman

Green

Carr

et al. 2012

FOC

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Morbidity due to avoidable medical errors is a crippling reality intrinsic to health care. In particular, iatrogenic surgical errors lead to significant morbidity, decreased quality of life, and attendant costs. In recent decades there has been an increased focus on health care quality improvement, with a concomitant focus on mitigating avoidable medical errors. The most notable tool developed to this end is the surgical checklist. Checklists have been implemented in various operating rooms internationally, with overwhelmingly positive results. Comparatively, the field of neurosurgery has only minimally addressed the utility of checklists as a health care improvement measure. Literature on the use of checklists in this field has been sparse. Considering the widespread efficacy of this tool in other fields, the authors seek to raise neurosurgical awareness regarding checklists by reviewing the current literature.

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Causes of neurological deficits following clipping of 200 consecutive ruptured aneurysms in patients with good-grade aneurysmal subarachnoid haemorrhage

Cited by 27 publications

References 25 publications

Incidence of Postoperative Hematomas Requiring Surgical Treatment in Neurosurgery: A Retrospective Observational Study

Incidence of Postoperative Hematomas Requiring Surgical Treatment in Neurosurgery: A Retrospective Observational Study

A 16 Year Experience with Modified Lateral Supraorbital Approach for Ruptured Cerebral Aneurysms

Neurosurgical checklists: a review

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