Cerebral Aneurysms: assessment of 50 cases operated on and comparison with previous series

Abstract

-A retrospective analysis of 50 patients who suffered subarachnoid hemorrhage (SAH) treated at UNICAMP between April 1988 and March 1992 is made, distributed as 34% in Hunt & Hess grade 1,38% in grade II, 16% in grade III, and 12% in grade IV. Males were predominant (66.6%), and patients age varied around 47± 12.13 years old. Only 13 patients (26%) were admitted within the first 24 hours after bleeding, with an overall average of 20.45 days of delay. From all cases only one had a rebleeding, survived and was submitted to surgery. Four patients died after surgery (8%). Timing of operation and prognostic chances were available, being 27.30 days after SAH for Hunt & Hess group I. It is analyzed also the timing for diagnosis -which responded for the most delay, and treatment for the other groups, and a historical comparison with previous series since year 1956 of the same Hospital were documented. Good results were observed in 38 cases (76%). The overall results in terms of mortality and morbidity is, in comparison, in accordance with the literature, and is ameliorated from the past series due to technical improvement, despite worsen difficulties in managing admittance, diagnosis and treatment faster, which is required to deal with the disease.KEY WORDS: subarachnoid hemorrhage, cerebral aneurysm, cerebral vasospasm.Aneurismas cerebrais: análise de 50 casos operados e comparação com séries anteriores RESUMO -Revisão cirúrgica de 50 pacientes portadores de aneurisma cerebral é realizada. O "timing "cirúrgico e prognóstico é bem documentado e comparado com séries anteriormente publicadas . A demora em se operar os pacientes foi devida à dificuldade de se realizar o diagnóstico (CT e angiografia). Observamos bons resultados em 38 casos (76%) e a taxa de mortalidade foi de 8% (4 casos). Os resultados finais estão, em comparação com a literatura, dentro do aceitável. PALAVRAS-CHAVE: hemorragia meníngea, aneurisma cerebral, vasoespasmo. The brain is unique among the organs of the body since it has no regenerative power and the highest metabolic needs. A ruptured cerebral aneurysm has the nefast property of causing subtle catastrophyc hemorrhages in the working brain, though bringing high morbidity and mortality to previously healthy individuals. This frequent course of subarachnoid hemorrhage (SAH) due to cerebral aneurysm has led to many attempts to ameliorate diagnosis and treatment, and several improvements were achieved analyzing the timing of onset of symptoms and clinical or surgical characteristics of series of patients who suffered from SAH, since the prevention of rupture of an intact and asymptomatic aneurysm still remains a dilemma l4I5lli . Delayed ischemic deficits due to cerebral vasospasm are well known. Several drugs have been evaluated in order to plead in favor of a better patient outcome [1][2][3][4][5][6][12][13][14]

Risk factors and outcome in 100 patients with aneurysmal subarachnoid hemorrhage

“…This could be attributed to technical difficulties of microdissection of the sylvian fissure or to an adverse aneurysm location. Microscopic dissection difficulties have been related by multiple logistic regression to thick arachnoid membrane and severe adherence between the frontal and the temporal operculae and, albeit increasing the surgical time, these factors are not directly related to any clinical consequence [32][33][34][35][36] . By consequence, the most important anatomical factor to predict an adverse outcome is an unfavorable location of the intracranial aneurysm and this should guide the pre-operative planning.…”

Evolução Funcional de Pacientes com Hemorragia Subaracnóide Aneurismática não Traumática

“…A ruptura de um aneurisma cerebral pode causar hemorragia catastrófica num cérebro sadio, ocasionando com isto alterações graves no estado clínico do paciente, com altas taxas de mortalidade e morbidade 4 . Aproximadamente 12% dos pacientes morrem antes de receber o tratamento medicamentoso 1 , 40% dos pacientes hospitalizados morrem com um mês após o evento, e mais de um terço dos que sobrevivem têm grandes déficits neurológicos 5,6 .…”

Aneurisma paraclinóideo: técnica cirúrgica e resultados em 51 pacientes

“…A exposição do segmento clinóideo da ACI para controle proximal apresenta desvantagens: sangramento do seio cavernoso, dificuldade de exposição dependente de curva de aprendizado, alem da parede da ACI ser mais frágil e aderente neste local 22 . Os APC são relativamente raros e tendem a ocorrer associados com outros aneurismas e acometem preferencialmente o sexo feminino [23][24][25][26][27][28] , diferente de algumas outras séries 29 .…”