Intracranial Operation Within Seven Days of Aneurysmal Subarachnoid Hemorrhage

Adams, Harold P.

doi:10.1001/archneur.1988.00520340019004

Cited by 15 publications

(2 citation statements)

References 26 publications

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“…Our regimen of ultra-early surgery is based on the now well-documented risk of rebleeding, which is highest within the first 6 to 12 hours after SAH. 1,2,4,24,33,41 Our series confirms that risk with a 12% ultra-early (Յ 12 hours post-SAH) rebleeding rate. This series cannot add to the debate between the relative merits of surgical and endovascular treatment of aneurysms, because the study period encompassed a time when we were unable to offer endovascular therapy routinely for aneurysms.…”

Section: Discussionsupporting

confidence: 79%

Ultra-early surgery for aneurysmal subarachnoid hemorrhage: outcomes for a consecutive series of 391 patients not selected by grade or age

Laidlaw

Siu²

2002

Journal of Neurosurgery

126

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Section: Discussionsupporting

confidence: 79%

Ultra-early surgery for aneurysmal subarachnoid hemorrhage: outcomes for a consecutive series of 391 patients not selected by grade or age

Laidlaw

Siu²

2002

Journal of Neurosurgery

126

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“…When surgery is delayed because of late admission to the hospital, a policy of delayed surgery, or unstated reasons, then the advantage of early surgery will be decreased or lost due to more favorable prognostic factors in the late-surgery groups. [2][3][4][5]27 Vasospasm-related deficits may then develop more commonly in patients operated on within 3 days of SAH. 5,25 Furthermore, presenting the results as surgical morbidity and mortality rather than management morbidity and mortality will also favor late surgery.3.4,7.…”

Section: Timing Of Surgery and Outcomementioning

confidence: 99%

The effect of surgery on the severity of vasospasm

Macdonald¹,

Wallace²,

Coyne³

1994

Journal of Neurosurgery

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Intracranial aneurysm surgery performed between 4 and 12 days after subarachnoid hemorrhage (SAH) has been associated with an increased risk of delayed cerebral ischemia and poor outcome compared to surgery performed before or after this time. To investigate whether this increased risk is due to aggravation of vasospasm, the angiograms obtained before and after surgery in 56 patients operated on at various times after aneurysmal SAH were studied. Vasospasm was quantitated by measuring the diameters of intracranial arteries and expressed as the ratio of the diameters of the intracranial arteries to the diameter of the extracranial internal carotid artery. Aggressive surgical clot removal was not performed at surgery. To correct for differences in prognostic factors for vasospasm between patients operated on at different times after SAH, multiple regression analysis was performed using the arterial diameter ratio during vasospasm as the dependent variable and the prognostic factors for vasospasm, including the time of surgery, as independent variables. Equations predicting the severity of vasospasm could be generated using the clinical grade on admission, patient age, and preoperative arterial diameter ratio. The time of surgery had no effect on vasospasm. Cerebral infarction due to vasospasm developed in five (15%) of 34 patients operated on within 3 days after SAH and in four (20%) of 20 operated on between 4 and 12 days after SAH (p = 0.66). A good outcome for these two groups was achieved in 88% and 85%, respectively (p = 1.00). These results suggest that the timing of surgery does not affect the development of vasospasm. Any increased risk of cerebral ischemia associated with surgery performed between 4 and 12 days after SAH is due to factors other than aggravation of vasospasm.

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Aneurysms Involving the Motor and Sensory Visual Pathways

Kupersmith

1993

Neurovascular Neuro-Ophthalmology

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Intracranial Operation Within Seven Days of Aneurysmal Subarachnoid Hemorrhage

Cited by 15 publications

References 26 publications

Ultra-early surgery for aneurysmal subarachnoid hemorrhage: outcomes for a consecutive series of 391 patients not selected by grade or age

Ultra-early surgery for aneurysmal subarachnoid hemorrhage: outcomes for a consecutive series of 391 patients not selected by grade or age

The effect of surgery on the severity of vasospasm

Aneurysms Involving the Motor and Sensory Visual Pathways

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