Controversies in the Anesthetic Management of Intraoperative Rupture of Intracranial Aneurysm

Chowdhury, Tumul; Petropolis, Andrea; Wilkinson, Marshall F.; Schaller, Bernhard; Sandu, Nora; Cappellani, Ronald B.

doi:10.1155/2014/595837

Cited by 19 publications

(18 citation statements)

References 77 publications

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“…Smoking appears to be associated with increased chances of IORin previous studies also. 6 No other identifiable risk factor was seem to be associated. We found that in few cases (9 patients), there were dense adhesions in the sylvian fissure and peri aneurysm.…”

Section: Discussionmentioning

confidence: 96%

The outcome after aneurysmal sub arachnoid hemorrhage: a study of various factors

Tewari

Aggarwal

Mathuriya

et al. 2015

ANS

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BackgroundAneurysmal subarachnoid hemorrhage (A-SAH), despite improvement in surgical and medical treatments, is still a serious disease with high fatality and morbidity rates. Despite the huge advances in neurosurgical management of the disease, there has not been a proportional improvement in outcome of this condition.PurposeWe studied various factors which can influence the final outcome and these included: World federation of neurosurgical societies (WFNS), Hunt & Hess (H&H) and Fisher grade, size of aneurysm, intra operative rupture (IOR), temporary clipping (TC) – and correlate their individual impact in final outcome.MethodsWe studied 100 patients of aneurysmal subarachnoid hemorrhage prospectively all of whom were operated upon .Post operative course was followed and final outcome studied.ResultsPre operatively, higher WFNS and H&H grades had a worse outcome. This correlation was not found for Fisher grade. Nonetheless, presence of IVH(Fisher grade 4) acted as an independent risk factor for poor outcome.ConclusionDiabetes and smoking led to a worse outcome in contrast to hypertension . IOR led to poor outcome while temporary clipping did not.

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Section: Discussionmentioning

confidence: 96%

The outcome after aneurysmal sub arachnoid hemorrhage: a study of various factors

Tewari

Aggarwal

Mathuriya

et al. 2015

ANS

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“…In these cases, the perioperative anesthetic management can have a significant effect on global neurological results by monitoring many factors, including the induction of anesthesia, the presence or absence of burst suppression, use of volatile agents/muscle relaxants, hemodynamic parameters, and temperature. In any case, these parameters must be assisted by intraoperative neurophysiological monitoring with EEG and evoked potentials [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Intracranial aneurysms and optic glioma – an unusual combination: a case report

et al. 2016

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BackgroundThe coexistence of glial high grade tumors (glioblastoma, anaplastic astrocytoma) and cerebral aneurysms is common but the association with optic glioma is rare. The treatment of these associated lesions is problematic.Case presentationA 36-year-old white woman presented to our institution with recurrent attacks of headache. Her preoperative radiological studies revealed a lesion of her left optic nerve with extension to the optic chiasma, an aneurysmatic dilatation of the left carotid bifurcation, a second aneurysm on the left of her middle cerebral artery, and a third one on her right anterior cerebral artery in the A2 tract. A left pterional approach was used to remove the tumor and clip the three aneurysmatic dilatations in a single stage.ConclusionsWe report this unusual case of optic glioma associated to multiples aneurysms and review the pertinent literature. An adequate knowledge of this association is mandatory to plan the correct approach to avoid complications.

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“…A gradual increase in blood pressure accompanied by a precipitous drop in heart rate may signal an IOR. Changes in the neurological exam may be difficult to assess given GA; however, raised intracranial pressure and herniation can be recognized clinically with a unilateral change in pupil size [12]. The anesthetic care of IOR is complex, and aneurysm rupture in a closed skull carries a worse prognosis due to elevation in intracranial pressure impairing cerebral perfusion [13].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Aneurysmal Subarachnoid Hemorrhage with Procedures Requiring General Anesthesia in Patients with Unruptured Intracranial Aneurysms

et al. 2018

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Background: The role of general anesthesia in precipitating aneurysm rupture is not clearly defined. In this study, we aimed to assess the natural history of unruptured aneurysms in patients undergoing non-aneurysm-related procedures requiring general anesthesia. Methods: Retrospective review of consecutive patients with untreated intracranial aneurysms that underwent unrelated surgery with operative note documentation of general anesthesia. Events of intraoperative and postoperative subarachnoid hemorrhage were recorded to determine the incidence of rupture. Results: A total of 110 patients harboring 134 unsecured aneurysms were studied. The mean age was 56.5 years (range, 17–92), and 68% were women (n = 75/110). Mean aneurysm size was 3.5 mm (range 1.5–17). A total of 208 procedures were performed under general anesthesia. There were no events of subarachnoid hemorrhage in 5.7 years of follow-up. Conclusion: In our study, general anesthesia did not precipitate aneurysm rupture, and there were no instances of subarachnoid hemorrhage during the follow-up period. Our results suggest a benign natural history for aneurysms undergoing unrelated general anesthesia. However, this should be interpreted with caution given limitations related to our small sample size and retrospective study design.

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Controversies in the Anesthetic Management of Intraoperative Rupture of Intracranial Aneurysm

Cited by 19 publications

References 77 publications

The outcome after aneurysmal sub arachnoid hemorrhage: a study of various factors

The outcome after aneurysmal sub arachnoid hemorrhage: a study of various factors

Intracranial aneurysms and optic glioma – an unusual combination: a case report

Incidence of Aneurysmal Subarachnoid Hemorrhage with Procedures Requiring General Anesthesia in Patients with Unruptured Intracranial Aneurysms

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