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Acute surgery in intracranial aneurysms. Experience with 100 cases
J Bidziński1, A Marchel, M Pastuszko
1Department of Neurosurgery, Medical Academy, Warsaw, Poland.
Acta Neurochirurgica
|January 1, 1990
Summary
Acute surgery for intracranial aneurysms within 72 hours of subarachnoid hemorrhage (SAH) showed good outcomes. Aggressive vasospasm treatment improved recovery, but hypertension posed challenges.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Subarachnoid hemorrhage (SAH) from intracranial aneurysms requires timely intervention.
- Acute surgical treatment is performed within 72 hours of SAH for select patients.
- Glasgow Outcome Scale (GOS) is used for patient outcome assessment.
Purpose of the Study:
- To evaluate the outcomes of acute surgical treatment for intracranial aneurysms.
- To assess the effectiveness of nimodipine and CSF drainage in managing SAH.
- To identify factors influencing patient recovery after aneurysm surgery.
Main Methods:
- Retrospective analysis of 100 patients undergoing acute surgery for intracranial aneurysms (up to 72h post-SAH).
- Patients were graded I-III using the World Federation of Neurosurgical Societies (WFNS) scale.
- Supratentorial aneurysms were treated with clipping, routine CSF drainage, and nimodipine administration (topical, IV, oral).
Main Results:
- 78 patients achieved full recovery, and 5 were independent at 1-year follow-up (GOS).
- 14 deaths occurred, 7 due to postoperative vasospasm.
- Symptomatic ischemia affected 25 patients, but 15 recovered fully due to aggressive antivasospasm therapy (hypervolemia, induced hypertension).
- Chronic arterial hypertension was associated with worse outcomes.
Conclusions:
- Acute surgical management of intracranial aneurysms within 72 hours can yield favorable outcomes.
- Aggressive vasospasm treatment strategies significantly improve neurological recovery.
- Patient comorbidities, such as chronic hypertension, negatively impact surgical results.