Abstract:RESUMO -Realizamos análise comparativa dos resultados clínicos e radiológicos após o tratamento de aneurisma roto, localizado no setor anterior, por cirurgia ou por via endovascular. Entre 1995 e 1999, 78 pacientes foram tratados em nosso serviço por apresentarem ruptura de aneurisma intracraniano com grau clínico (Hunt & Hess) variando entre I e III. Dentre estes pacientes, 52 foram operados, 21 embolizados e 5 fizeram tratamento combinado. Dos casos cirúrgicos, o resultado clínico foi considerado ótimo em 80… Show more
“…It was also observed in the articles that the treatments used for aneurysmal SAH varied. These information show that the objectives set out in the studies were modified with the evolution of medical interventions, considering the period of publication, since that the first articles addressed the craniotomy (11,14,15,18,19) and the most recent ones are set out to analyze smell also in embolization (12)(13)(14)17) , which is a more recent technique (24) .…”
Heterogeneity was observed in the methods used to evaluate the smell in aneurysmal subarachnoid hemorrhage and in the methods selected for application of evaluations. In addition, studies have demonstrated the existence of olfactory deficits in patients and the relationship between surgery and olfactory dysfunction.
“…It was also observed in the articles that the treatments used for aneurysmal SAH varied. These information show that the objectives set out in the studies were modified with the evolution of medical interventions, considering the period of publication, since that the first articles addressed the craniotomy (11,14,15,18,19) and the most recent ones are set out to analyze smell also in embolization (12)(13)(14)17) , which is a more recent technique (24) .…”
Heterogeneity was observed in the methods used to evaluate the smell in aneurysmal subarachnoid hemorrhage and in the methods selected for application of evaluations. In addition, studies have demonstrated the existence of olfactory deficits in patients and the relationship between surgery and olfactory dysfunction.
“…O índice de oclusão total dos aneurismas é 52 a 78% 13 , com presença de colo residual, em vista da angiografia inicial em 42,4%. Os aneurismas residuais, ocorrem em 4,8% 14 .A oclusão incompleta pode acarretar ressangramento 15,16 , com incidência anual de 0,5% 13 , índice este correspondente a história natural desses aneurismas 1 . É opinião dos autores que a técnica microcirúrgica para o tratamento dos aneurismas, diferente do tratamento endovascular, permite a confirmação per-operatória da clipagem, além de possuir seguimento longo, dispensado portanto a realização de angiografia pós-operatória e sua morbidade associada.…”
Descrevemos nossa experiência no tratamento microcirúrgico de 34 pacientes portadores de aneurismas não rotos da artéria cerebral média. Houve prevalência no sexo masculino. Oitenta e três por cento dos aneurismas apresentava tamanho menor que 10 mm. Não houve óbito na presente série, com morbidade de 3% após 1 ano. Indicamos, portanto, microcirurgia como tratamento de escolha para os aneurismas não rotos da artéria cerebral média.
Object. The present purpose is to define the sensitivity of the superiority of coil embolization observed in the International Subarachnoid Aneurysm Trial (ISAT) according to the rate of late rebleeding over a reasonable range, and to find the range of rebleeding rates for which it may be overturned. In the ISAT, coil embolization appears to be safer than clip ligation at 1 year, and clip occlusion has better long-term efficacy at preventing rebleeding. This leaves open the question of which is better in the longer term.Methods. The authors calculate the life expectancy of patients following a subarachnoid hemorrhage (SAH) and compare the life expectancy of those who underwent coil embolization with those who underwent clip ligation in the ISAT cohort.Results. The 1-year poor outcome rate following treatment climbs rapidly with advancing age. A consequence is that the absolute difference between the poor outcome rates after coil embolization and clip occlusion is lower in those Ͻ 50 years of age (3.3%) than it is for those Ͼ 50 years of age (10.1%). This difference may be enough to give clip application the advantage in the Ͻ 40-year-old group despite the small size of the difference in 1-year rebleeding rates thus far observed (0.152%).Conclusions. When treating ruptured cerebral aneurysms, the advantage of coil embolization over clip ligation cannot be assumed for patients Ͻ 40 years old. In this age range the difference in the safety of the 2 procedures is small, and the better long-term protection from SAH afforded by clip placement may give this treatment an advantage in life expectancy for patients Ͻ 40 years of age.
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