Results of Direct Surgery for Aneurysmal Subarachnoid Haemorrhage: Outcome of 2055 Patients who Underwent Direct Aneurysm Surgery and Profile of Ruptured Intracranial Aneurysms

2001 ◽  
Vol 143 (7) ◽  
pp. 655-664 ◽  
Author(s):  
M. Osawa ◽  
K. Hongo ◽  
Y. Tanaka ◽  
Y. Nakamura ◽  
K. Kitazawa ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Aneurysm Surgery ◽  
Ruptured Intracranial Aneurysms

scholarly journals Pipeline shield with single antiplatelet therapy in aneurysmal subarachnoid haemorrhage: multicentre experience

2018 ◽  
Vol 11 (7) ◽  
pp. 694-698 ◽  
Author(s):  
Nathan W Manning ◽  
Andrew Cheung ◽  
Timothy J Phillips ◽  
Jason D Wenderoth
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Antiplatelet Therapy ◽  
Acute Treatment ◽  
Intracranial Aneurysms ◽  
World Federation ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Anterior Circulation ◽  
Heparin Infusion ◽  
Poor Grade ◽  
Ruptured Intracranial Aneurysms

BackgroundThe Pipeline Embolisation Device with Shield technology (PED-Shield) is suggested to have reduced thrombogenicity. This reduced thrombogenicity may make it possible to use safely in the acute treatment of aneurysmal subarachnoid haemorrhage (aSAH) on single antiplatelet therapy (SAPT).ObjectiveTo evaluate the safety and efficacy of the off-label use of PED-Shield with SAPT for the acute treatment of aSAH.MethodsPatients who underwent acute treatment of ruptured intracranial aneurysms with the PED-Shield with SAPT were retrospectively identified from prospectively maintained databases at three Australian neurointerventional centres. Patient demographics, aneurysm characteristics, clinical and imaging outcomes were reviewed.ResultsFourteen patients were identified (12 women), median age 64 (IQR 21.5) years. Aneurysm morphology was saccular in seven, fusiform in five, and blister in two. Aneurysms arose from the anterior circulation in eight patients (57.1%). Six (42.9%) patients were poor grade (World Federation of Neurological Societies grade ≥IV) SAH. Median time to treatment was 1 (IQR 0.5) day. Complete or near complete aneurysm occlusion (Raymond-Roy <3) was achieved in 12 (85.7%) patients at the end of early-acute follow-up (median day 7 after SAH). Permanent, treatment-related morbidity occurred in one (7.1%) patient and one (7.1%) treatment-related death occurred. The use of a postoperative heparin infusion (n=5) was associated with a higher rate of all complications (80.0% vs 11.1%, p=0.023) and symptomatic complications (60% vs 0.0%, p=0.028). No symptomatic ischaemic or haemorrhagic complications were observed in the patients who did not receive a post-operative heparin infusion. Nine (64.3%) patients were functionally independent on discharge from the treatment centre.ConclusionThe PED-Shield may be safe to use in the acute treatment of ruptured intracranial aneurysms with SAPT. Further investigation with a formal treatment registry is needed.

scholarly journals Smoking habits and detection rate of unruptured intracranial aneurysms and incidence rate of subarachnoid haemorrhage in Norway between 2008 and 2015

2020 ◽  
Vol 162 (12) ◽  
pp. 3161-3165
Author(s):  
Paulina Majewska ◽  
Sasha Gulati ◽  
Lise Øie ◽  
Øyvind Salvesen ◽  
Tomm B. Müller ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Incidence Rate ◽  
Intracranial Aneurysms ◽  
Detection Rate ◽  
Hazard Ratio ◽  
Smoking Habits ◽  
Daily Smoking ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Age Group ◽  
Unruptured Intracranial Aneurysms

Abstract Objective The aim of this study was to investigate the detection rate of unruptured intracranial aneurysms (UIAs) and incidence of aneurysmal subarachnoid haemorrhage (SAH) in relation to the rapidly changing smoking rates in Norway between 2008 and 2015. Methods The registry-based study included all patients (≥ 16 years old) admitted to a hospital in Norway between 2008 and 2015 with a primary diagnosis of aneurysmal SAH or an outpatient diagnosis of UIAs. Age group–specific and total detection rate of UIAs and incidence rate of SAH over the years were calculated. Age group–specific data on smoking habits was retrieved from a national annual survey representative of the whole Norwegian population. Results The rate of daily smokers decreased by 48% between 2008 and 2015. The detection rate of UIAs decreased by 47% from 17.3 in 2008 to 9.3 per 100,000 persons in 2015, and the incidence of SAH decreased by 30% from 11.3 in 2008 to 7.9 per 100,000 persons in 2015. The average annual decline in prevalence of daily smoking, UIA detection rate, and SAH incidence was 6.9%, 6.7%, and 4.3% per year, respectively. Multinomial logistic regression analyses revealed that the correlation between the decline in estimated daily smoking rates and decline in detection rate of UIAs (hazard ratio 52.5 CI = (14.9,∞), p < 0.00001) and incidence of SAH (hazard ratio 11.8 CI=(5.6,32.5), p < 0.00001) are statistically significant. The association is particularly strong in young and middle-aged cohorts (< 66 years old). Conclusion It is likely that reducing cigarette smoking on a population-based level strongly reduces the rates of UIAs and SAH.

Anosmia following operation for cerebral aneurysms in the anterior circulation

1990 ◽  
Vol 72 (6) ◽  
pp. 864-865 ◽  
Author(s):  
Kjeld Dons Eriksen ◽  
Torben Bøge-Rasmussen ◽  
Christian Kruse-Larsen
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Olfactory Nerve ◽  
Aneurysm Surgery ◽  
Anterior Circulation ◽  
Widespread Occurrence ◽  
Content Type ◽  
High Incidence ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

✓ Damage to the olfactory nerve during frontotemporal approach to the basal cisternal region has not previously been investigated in a quantified manner. In this retrospective study of 25 patients operated on for ruptured intracranial aneurysms via the frontotemporal route, 22 patients suffered postoperatively from anosmia ipsilateral to the side of surgery. This complication most often goes unrecognized by the patient as well as the physician, and attention should be drawn to it because of its widespread occurrence. This investigation demonstrates a high incidence of anosmia (24 (88.9%) of 27 surgical sides) occurring ipsilateral to the frontotemporal approach in aneurysm surgery. Recovery after traumatic anosmia has been recorded up to 5 years after injury.1 Nevertheless, the authors believe that the damage is permanent when lasting 35 months or longer.

Significance of vasospasm in the treatment of ruptured intracranial aneurysms

1977 ◽  
Vol 47 (3) ◽  
pp. 412-429 ◽  
Author(s):  
Isamu Saito ◽  
Yasuichi Ueda ◽  
Keiji Sano
Keyword(s):  
Intracranial Aneurysms ◽  
Surgical Intervention ◽  
Blood Clot ◽  
Timing Of Surgery ◽  
Neurological Deficits ◽  
Aneurysm Surgery ◽  
Content Type ◽  
Ruptured Intracranial Aneurysm ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

✓ The authors have analyzed a total of 96 consecutive cases in which vasospasm followed subarachnoid hemorrhage (SAH). The SAH was caused by ruptured intracranial aneurysm or developed after aneurysm surgery. Usually at least 4 days elapsed between SAH and the onset of vasospasm. Vasospasm subsided an average of 2 weeks after onset. Of 68 patients with preoperative vasospasm, eight died due to cerebral edema resulting from ischemia, and 49% of the survivors had neurological deficits. Preoperative vasospasm was not aggravated by surgical intervention when operations were carried out more than 7 days after the onset of vasospasm. Postoperative vasospasm was found in 25 of 52 patients who underwent operation within 1 week after SAH (excluding cases in Grade V). Five of these patients died, all of whom underwent surgery between the fourth and seventh day after SAH (the day of SAH was counted as the first day). There were no deaths among 20 patients operated on within the first 3 days after SAH. Postoperative vasospasm was always mild in these cases, when it occurred, probably because blood clot or blood-stained cerebrospinal fluid was removed by operative procedures. In all cases, 4 to 11 days elapsed between the last SAH and the onset of postoperative vasospasm regardless of the timing of surgery.

scholarly journals The Genetics of Primary Haemorrhagic Stroke, Subarachnoid Haemorrhage and Ruptured Intracranial Aneurysms in Adults

PLoS ONE ◽  
2008 ◽  
Vol 3 (11) ◽  
pp. e3691 ◽  
Author(s):  
George Peck ◽  
Liam Smeeth ◽  
John Whittaker ◽  
Juan Pablo Casas ◽  
Aroon Hingorani ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Intracranial Aneurysms ◽  
Haemorrhagic Stroke ◽  
Ruptured Intracranial Aneurysms

The International Cooperative Study on the Timing of Aneurysm Surgery

1990 ◽  
Vol 73 (1) ◽  
pp. 37-47 ◽  
Author(s):  
Neal F. Kassell ◽  
James C. Torner ◽  
John A. Jane ◽  
E. Clarke Haley ◽  
Harold P. Adams ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Intracranial Aneurysms ◽  
Early Surgery ◽  
Surgical Results ◽  
Aneurysm Surgery ◽  
Cooperative Study ◽  
Content Type ◽  
Delayed Surgery ◽  
Postoperative Risk ◽  
Ruptured Intracranial Aneurysms

✓ A prospective, observational clinical trial was conducted by the International Cooperative Study on the Timing of Aneurysm Surgery to determine the best time in relation to the hemorrhage for surgical treatment of ruptured intracranial aneurysms. Sixty-eight centers contributed 3521 patients in a 2½-year period beginning in December, 1980. Analysis by a prespecified “planned” surgery interval demonstrated that there was no difference in early (0 to 3 days after the bleed) or late surgery (11 to 14 days). Outcome was worse if surgery was performed in the 7 to 10-day post-bleed interval. Surgical results were better for patients operated on after 10 days. Patients alert on admission fared best; however, alert patients had a mortality rate of 10% to 12% when undergoing surgery prior to Day 11 compared with 3% to 5% when surgery was performed after Day 10. Patients drowsy on admission had a 21% to 25% mortality rate when operated on up to Day 11 and 7% to 10% with surgery thereafter. Overall, early surgery was neither more hazardous nor beneficial than delayed surgery. The postoperative risk following early surgery is equivalent to the risk of rebleeding and vasospasm in patients waiting for delayed surgery.

Cerebral vasospasm following aneurysm rupture

1980 ◽  
Vol 52 (2) ◽  
pp. 149-152 ◽  
Author(s):  
Alan S. Fleischer ◽  
George T. Tindall
Keyword(s):  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Volume Replacement ◽  
Aneurysm Surgery ◽  
Preoperative Period ◽  
Circulating Blood Volume ◽  
Content Type ◽  
Ruptured Intracranial Aneurysms ◽  
Grade Iii ◽  
Fine Print

✓ A retrospective study was made of 195 patients who had ruptured intracranial aneurysms without significant intracerebral hematomas and who recovered to at least Grade III by Hunt and Hess' classification. The first 121 patients underwent aneurysm surgery 10 days to 2 weeks after subarachnoid hemorrhage (SAH) without repeat preoperative angiography and without special attention to volume replacement or avoidance of hypotension. Vasospasm resulted in cerebral ischemia in 15% of this group, more than half of these postoperatively, and was treated successfully in half the patients with a combination of aminophylline and isoproterenol. The later 74 patients were managed with aggressive maintenance of normal circulating blood volume and preoperative angiography at 2 weeks following SAH. If significant vasospasm persisted on angiography, surgery was delayed an additional week and, if spasm was still present then, aminophylline and isoproterenol were added prophylactically to aggressive volume replacement before surgery. In this second group of patients, the incidence of clinical vasospasm was essentially unchanged; however, it was almost completely limited to the preoperative period, and was more effectively treated with aminophylline and isoproterenol. Postoperative vasospasm was almost completely eliminated from the second group of patients.

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