Timing and Techniques in the Intracranial Surgery of Ruptured Aneurysms of the Anterior Communicating Artery

Jl, Pool

doi:10.3171/jns.1962.19.5.0378

Cited by 68 publications

(8 citation statements)

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“…In most reports only the mortality rate has been discussed (Botterell et al 1958 Hunt 1974), and others include the morbidity classification of two groups, ability and disability in daily life (Poppen and Fager 1960;Pool 1962). The two-group classification does not correctly reflect the consequences of aneurysm surgery.…”

Section: Results At Follow-upmentioning

confidence: 99%

“…The strict and uniform criteria are essential for evaluation of surgical results (Pool 1962;Sahs et al 1969;Drake 1971;Krayenbuhl et al 1972). In most reports only the mortality rate has been discussed (Botterell et al 1958 Hunt 1974), and others include the morbidity classification of two groups, ability and disability in daily life (Poppen and Fager 1960;Pool 1962).…”

Section: Results At Follow-upmentioning

confidence: 99%

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Intracranial Saccular Aneurysms - Surgical Results of 1, 000 Consecutive Cases

Kayama

Yoshimoto

Uchida

et al. 1978

Tohoku J. Exp. Med.

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results of our surgical treatment of 1,000 patients with intracranial saccular aneurysm were analyzed with special consideration for age, site of aneurysm, preoperative condition and operative timing. The results on discharge were as follows: 543 cases, excellent; 186, good; 117, fair; 93, poor; and 61, dead. About three-fourths of the cases except for 23 cases of vertebrobasilar aneurysm showed either excellent or good result.The mortality rate became worse with aging. The results fairly correlated with the preoperative grades by Hunt and Hess (1968), but the cases of Grade la were unexpectedly worse. The timing of operation influenced the mortality rate; especially, the cases operated within 3 to 7 days following the last subarach noid hemorrhage bore poor results.Follow-up studies revealed that excellent and good cases increased and poor cases decreased. The mortality rate for each year decreased annually to 2% in 1975. This improvement may be attributed to the advancement in the operative management with supplementary procedures and in the treatment for cerebral angiospasms and general condition. intracranial saccular aneurysm ; surgical result

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Section: Results At Follow-upmentioning

confidence: 99%

Section: Results At Follow-upmentioning

confidence: 99%

Intracranial Saccular Aneurysms - Surgical Results of 1, 000 Consecutive Cases

Kayama

Yoshimoto

Uchida

et al. 1978

Tohoku J. Exp. Med.

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“…3 Later, Pool advocated early surgery in the young patients. 3,4 In 1990, the cooperative study on SAH concluded that early surgery was neither beneficial nor hazardous compared to a delayed intervention. The outcome was found to be worse if surgery was performed 7 to 10 days after the bleed.…”

Section: Introductionmentioning

confidence: 99%

Vasospasm: A friend or foe - initial experience

Mukherjee

Chhabra

2012

ANS

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BackgroundThe optimal time to operate on an intracranial aneurysm eludes a satisfactory answer. While most surgeons would agree to operate early in young and neurologically intact patients, the ideal timing in older and neurologically impaired patients is debatable. In India, the majority of centers operate on patients in Hunt and Hess grades I-III, but is circumspect about grades IV and V.PurposeThe following study was carried out to check the effect of vasospasm on mortality rates and time of surgery being performed on the patient after having the same in patients coming under criteria of Hunt and Hess grades IV and VMethodsWe undertook a prospective evaluation of 171 consecutive patients of aneurysms operated during the last 9 years irrespective of their age, neurological grade, and time of presentation or vasospasm in an attempt to resolve this issue. The influence of vasospasm on each neurological grade was examined.ResultsIt appears that concomitant presence of vasospasm in grade III, IV and V patients indicates a possible “reversible” cause of the poor neurological status, while its absence may indicate an irreversible or more extensive primary insult.ConclusionThe presence of vasospasm in poor grade patients appears to be a better prognostic indicator.

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“…Despite the fact that, thanks to improvements in neuroradiology, anaesthesia, surgical technique, in the following years, many favourable reports of intracranial operative approach had been published 46,54,55 , larger studies continued to show highly disap-La chirurgia degli aneurismi che hanno sanguinato RIASSUNTO -Il confronto fra le casistiche basate su chirurgia precoce e tardiva dimostra una marcata riduzione della mortalità ed un incremento generale dei risultati buoni nel caso dei trattamenti con chirurgia precoce.…”

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Surgery for Bleeding Aneurysms

Fontanella

Pagni

2002

Rivista di Neuroradiologia

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The comparison between the overall results in series treated with late surgery and those obtained with early surgery demonstrates a marked reduction of mortality and an increase in good results in the series treated with early surgery. In many series in which a protocol of late surgery was employed no less than 10-15% percent of the patients died waiting for the operation.The advantage of early surgery is much more evident if the results are analysed on the basis of the Hunt-Hess grade on admission. In the past, some of the surgeons who considered early surgery an useful weapon for patients in Hunt-Hess I-II, thought that early surgery was too risky in Hunt-Hess III, and that grade IV and V patients should not undergo surgery.In Hunt-Hess III operative mortality and morbidity were respectively 15-30% and 10-25% with delayed surgery, but the overall mortality is up to 40% mainly due to the rebleeding rate. Operative result and overall outcome in Hunt-Hess III is much better in series treated in early surgery with Nimodipine, ventricular drainage and intracranial pressure control. In the past, the approach to Grade IV and V patient was usually nonoperative.This has changed today, since early surgical treatment is increasingly done also in these groups of patients. In our experience, the endovascular approach can be a good alternative in many cases. Such considerations are valid also for those patients, usually in severe clinical condition, with an intracerebral haematoma. Posterior circulation aneurysms have usually been operated on in late surgery.In these cases a careful selection of patients, the surgical approach and improvement in neurointensive care techniques to obtain more operating space and to minimize retraction, allow satisfactory results also with early surgery. Only a few series reported the results of early surgery in giant aneurysms. On the basis of those papers it can safely be affirmed that if the sac is clippable with the usual surgical technique, an early approach can be attempted. If temporary prolonged arterial occlusion or by-pass seem to be necessary, it is better to postpone surgery.

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Timing and Techniques in the Intracranial Surgery of Ruptured Aneurysms of the Anterior Communicating Artery

Abstract: NEURYSMS Of the anterior communicating artery are notoriously difficult to treat either by conservative or surgical means. Conservative therapy has led to a mortality ranging from 44.5 per cent (Logue 4) to 5~ per cent (McKissock el al. 6) while

Cited by 68 publications

References 8 publications

Intracranial Saccular Aneurysms - Surgical Results of 1, 000 Consecutive Cases

Intracranial Saccular Aneurysms - Surgical Results of 1, 000 Consecutive Cases

Vasospasm: A friend or foe - initial experience

Surgery for Bleeding Aneurysms

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