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Unruptured aneurysms and postoperative volume expansion.
1Department of Neurological Surgery, Columbia-Presbyterian Medical Center, New York.
Journal of Neurosurgery
|December 1, 1992
Summary
Prophylactic hypervolemic hypertension is safe and beneficial for preventing delayed cerebral ischemia in patients with ruptured brain aneurysms, even those with untreated aneurysms. This treatment did not lead to any aneurysm ruptures in the study group.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Aneurysmal subarachnoid hemorrhage (aSAH) management involves preventing delayed cerebral ischemia (DCI).
- The use of aggressive hemodynamic management (volume expansion and induced hypertension) is debated in patients with unsecured aneurysms due to rupture risk.
Purpose of the Study:
- To evaluate the safety and efficacy of prophylactic hypervolemic hypertension in preventing DCI after aSAH surgery.
- To assess the risk of aneurysm rupture during aggressive hemodynamic management in patients with unsecured aneurysms.
Main Methods:
- Retrospective analysis of 199 patients with aSAH undergoing early surgery.
- 31 patients had unsecured aneurysms postoperatively.
- All patients received prophylactic volume expansion; 8 required additional induced hypertension for DCI symptoms.
Main Results:
- No unsecured aneurysms ruptured during hypervolemic or hypertensive treatment.
- Eight patients developed DCI symptoms and received induced hypertension.
- Four of these patients improved, while four developed cerebral infarcts; one patient died from refractory vasospasm.
Conclusions:
- Prophylactic hypervolemic hypertension is a safe and effective strategy for preventing DCI in aSAH patients.
- The benefits of this treatment outweigh the risks, even in the presence of unsecured aneurysms.
- Aggressive hemodynamic management can be cautiously employed in select patients with unsecured aneurysms.