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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
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Surgical intervention for cerebral amyloid angiopathy-related lobar intracerebral hemorrhage: a systematic review
Ole F de Bruin1, Sabine Voigt1,2, Jan W Schoones3
1Departments of1Neurology.
Journal of Neurosurgery
|April 5, 2024
Summary
Surgery for cerebral amyloid angiopathy (CAA)-related intracerebral hemorrhage (ICH) shows low risks of intraoperative and postoperative bleeding. However, patient outcomes are often poor, particularly in older individuals, highlighting the need for further research.
Area of Science:
- Neurosurgery
- Neurology
- Clinical Research
Background:
- Cerebral amyloid angiopathy (CAA)-related lobar intracerebral hemorrhage (ICH) poses significant risks.
- The efficacy and safety of surgical interventions for CAA-related ICH remain largely undetermined.
Approach:
- A systematic review adhering to the 2020 PRISMA statement was conducted.
- Literature searches encompassed multiple databases (PubMed, MEDLINE, Embase, Web of Science, Cochrane Library, Emcare, Academic Search Premier) up to December 27, 2022.
- Included studies were RCTs, cohort studies, cross-sectional designs, or case series (n>5) meeting CAA and ICH criteria, focusing on peri/postoperative outcomes.
Key Points:
- Analysis of 4 cohort studies and 15 case series (n=738) revealed low intraoperative hemorrhage (0.6%) and variable postoperative hemorrhage rates (13.0% <48h, 6.2% 48h-14d).
- Overall recurrent ICH occurred in 11% of patients.
- Poor outcomes were prevalent, with a 19% 3-month mortality rate and only 23% good outcomes, influenced by factors like advanced age and comorbidities.
Conclusions:
- Surgical intervention for CAA-related ICH appears safe regarding immediate hemorrhage risks.
- Outcomes are predominantly poor, especially in elderly patients, though evidence quality is limited.
- Excluding CAA patients from ICH surgery RCTs may hinder future subgroup analyses.
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