In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.
Ophthalmological screening of patients with histories of transient or prolonged comas after ruptured cerebral aneurysms very sensitively identifies patients with ocular hemorrhages, which are relatively common in patients with subarachnoid hemorrhage treated in an academic neurosurgical practice. The present study underestimates the true incidence of Terson's syndrome in that patients who died shortly after their subarachnoid hemorrhage were not included. Vitrectomy for patients who do not exhibit spontaneous improvement in vision results in a dramatic reversal of blindness.
Published reports of cure, morbidity, and mortality associated with the embolization of 1246 brain arteriovenous malformations during the last 35 years were reviewed. Embolization resulted in cure in 5% of arteriovenous malformations. The cure rates of embolization were 4% in reports of 708 patients published before 1990 and 5% in reports of 538 patients published since 1990 (P = not significant). Temporary morbidity from embolization was 10%, and permanent morbidity was 8%. Permanent morbidity was 9% before 1990 and 8% since 1990 (P = not significant). Death after embolization of brain arteriovenous malformations occurred in 1% of patients. Mortality associated with the embolization was 2% before 1990 and 1% since 1990 (P = not significant). Long-term morbidity associated with the use of neurotoxic embolization materials is worrisome but has never been proven.
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