[Neurosurgical aspects of the apallic problem]

In the period from 1965 to 1974, 77 patients with an apallic syndrome were observed at the Surgical University Clinic of Innsbruck. Main cause was cerebral contusion (35 patients) followed by open fracture of the skull (7), acute subdural haematoma (7), aneurysm (7), epidural haematoma (6), cerebral tumours (4), perforating skull lesion and traumatic intracerebral haematoma (2 each). 43 patients died, 5 showed spontaneous healing and 9 a rehabilitation effect. Defect healings occurred 12 times. For 23 patients, the survival times were up to 3 months and for 4 patients one year. Patients with healed defects were followed up for more than 10 years. The calculation of the nursing costs as compared to a simple surgical case showed an eight times higher value. However, the financial expenditure for drugs and laboratory findings decreased considerably from about the forth week. The large amount of nursing means and the high cost for personnel remained. Of the 285 patients of the years 1965 to 1974, who were unconscious during a period of up to one week, 59 became apallic. Of these, 27 survival, three were healed, 8 in rehabilitation, 5 as permanent nursing cases and 2 as defect healing. No clinical or intrumental methods can be found by means of which a prediction is possible whether the patient will be healed or become will develop an apallic syndrome.