Surgical Treatment of Severe Cases of Ruptured Intracranial Aneurysm in the Acute Stage

Sekiguchi, Kentaro; Sato, Susumu; Inoue, Akira; Morii, Ken; Sato, Mitsuya; Sorimachi, Takatoshi

doi:10.2335/scs1987.17.3_246

Cited by 1 publication

(3 citation statements)

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“…However, especially in patients with severe SAH without ICH, primary brainstem damage due to a peri-brainstem clot is not relieved by such therapy. The rate of favourable outcome in such patients, even with an improving neurological status when examined, remains dismal [17,21]. Thus we postulate that early aneurysmal surgery after observation of the clinical course in these patients may be of little help in relieving primary brain damage, especially in cases involving primary brainstem damage.…”

Section: Existing Treatment Policy For Severe Sah Patientsmentioning

confidence: 92%

“…Neurosurgeons in Japan who emphasize that early aneurysmal neck obliteration is beneficial in SAH patients tend to perform aggressive surgery in even poor-grade patients when neurological improvement is achieved after admission [4,16,17,21,28,29]. This practice is founded on the premise that the primary brain damage in these patients tends to be reversible.…”

Section: Existing Treatment Policy For Severe Sah Patientsmentioning

confidence: 99%

“…Many of these patients are usually not treated aggressively with any regimen, including obliteration of the aneurysmal neck. On the other hand, it is appreciated that the prognosis of patients with a severe SAH, yet an improving neurological examination seen after admission, is relatively good; these patients are usually actively treated [4,16,17,21,28,29]. However, there have been few studies of the clinical characteristics and prognoses of such patients, and the consensus of opinion among neurosurgeons is not uniform, especially regarding patients with severe SAH without intracerebral haemorrhage (ICH) due to primary aneurysm rupture.…”

Section: Introductionmentioning

confidence: 99%

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Early aneurysm surgery and dehydration therapy in patients with severe subarachnoid haemorrhage without ICH

1996

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We prospectively analysed treatment results in patients with severe subarachnoid haemorrhage (SAH) who underwent early aneurysm surgery, and were managed by dehydration therapy. We studied a total of 31 patients with poor-grade SAH including 18 in grade IV, and 13 in grade V according to the WFNS classification system. Patients who were older than 70 years of age, or those with an intracerebral haemorrhage or absent brainstem response were excluded from this study. At surgery, clot evacuation from the peri-brainstem cisterns with/without external decompression was performed following obliteration of the aneurysmal neck. In the early postoperative period, patients were maintained in negative water balance using osmotic diuretics. When delayed ischaemic deficits had manifested themselves, the pulmonary wedge pressure and/or central venous pressure was immediately increased by the rapid injection of albumin until hypovolaemia reverted to normovolaemia with the continuous administration of dobutamine. The outcome at 3 months was good recovery in 16 (52%) patients, moderate disability in 3 (10%), severe disability in 5 (16%), a vegetative state in 1 (3%), and death in 6 (19%). We though that early aneurysm surgery and postoperative dehydration therapy in the acute stages of brain oedema resulting from primary brain damage are effective in the treatment of patients with severe SAH but reversible primary brain damage.

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Section: Existing Treatment Policy For Severe Sah Patientsmentioning

confidence: 92%