The International Cooperative Studyon the Timing of Aneurysm Surgery

Abstract

The International Cooperative Study on the Timing of Aneurysm Surgery evaluated the results of surgical and medical management in 3521 patients between December, 1980, and July, 1983. At admission, 75% of patients were in good neurological condition and surgery was performed in 83%. At the 6-month evaluation, 26% of the patients had died and 58% exhibited a complete recovery. Vasospasm and rebleeding were the leading causes of morbidity and mortality in addition to the initial bleed. Predictors for mortality included the patient's decreased level of consciousness and increased age, thickness of the subarachnoid hemorrhage clot on computerized tomography, elevated blood pressure, preexisting medical illnesses, and basilar aneurysms. The results presented here document the status of management in the 1980's.

Trends in Surgical and Management Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage in Izumo City, Japan, between 1980–1989 and 1990–1998

“…Reports on the overall outcome of SAH can be classified broadly into those from epidemiological studies and those from referral centers or large-scale cooperative studies, but differences between them are apparent [2, 12, 13, 17, 30, 31, 32, 33, 39, 40, 41, 42, 43, 44]. According to community-based studies other than that from Izumo, 3–21% of patients with SAH died before receiving medical attention [45]and overall case fatality rates were 15–42% in the first week [1, 8, 11, 15, 25, 43], 33–54% at 3 weeks [2, 11, 46, 47], 20–61% at 1 month [8, 10, 11, 12, 13, 14, 16, 25, 30, 31, 32, 33, 39, 42, 43, 44, 48, 49, 50, 51], 29–44% at 6 months [11, 14, 52]and 33–77% at 1 year [8, 11, 25, 30, 39, 42, 44, 48].…”

“…It has been well established that the management outcome depends on the clinical grading [7, 20, 24, 25, 27, 41], age [3, 7, 13, 19, 20, 22, 24, 27, 28, 29, 41], rebleeding [7, 21, 23], SAH on CT scans [7, 41], the timing of admission [20, 22]and the aneurysm site [7, 41], associated with survival of patients with ruptured aneurysms. However, there have been few community-based studies dealing with predictors of outcome in patients with SAH [7, 12, 24].…”

“…In addition, in patients who were treated surgically, the incidence of permanent symptomatic vasospasm decreased significantly in period B compared with period A and, in the later period, the case fatality rate due to vasospasm reached 0%. In the International Cooperative Study on the Timing of Aneurysm Surgery [41], cerebral vasospasm was the leading cause of mortality and morbidity in addition to the initial bleed and rebleeding; cerebral vasospasm accounted for 28% of the mortality and for 39% of the morbidity. At present, cerebral vasospasm may not be the major cause of death in patients with SAH, and one of the most likely explanations for the decreasing trend in the case fatality rate is a decrease in the incidence of permanent symptomatic vasospasm.…”

Management of subarachnoid haemorrhage in a non‐neurosurgical centre

“…Non-contrast CT scanning is the investigation of choice. If performed within 48 h, it will identify SAH in 90-95% of cases [31,32]. Characteristic high density (white) areas are seen within the basal cisterns (Fig.…”

Clinical outcomes of surgical clipping for intracranial aneurysms in patients with a Hunt and Hess grade 4 or 5

“…This treatment mode produced a favorable result in 3.8-18% of cases, with a mortality rate of 68-87.4%. Later in early 1990s, several clinical reports indicated that early aggressive medical and surgical treatment could lead to better outcomes, with success rates that ranged from 7% to 42.6% 3,4,6,7 . With hundreds of varieties of aneurysm clips in different shapes and sizes, surgical clipping has been the gold standard for the treatment of both ruptured and unruptured cerebral aneurysms since the 1960s due to the the mechanical complexity of existing clips as well as the emergence of the operating microscope.…”