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Ruptured intracranial aneurysms. Case morbidity and mortality
Insights
This study on ruptured intracranial aneurysms found that active medical management before surgery significantly reduced patient morbidity and mortality. This approach improved long-term survival rates for patients with brain aneurysms.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Ruptured intracranial aneurysms pose significant risks of rebleeding, neurological deficit, and death.
- Optimal management strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a comprehensive treatment regimen, including medical management and microsurgical intervention, on morbidity and mortality in ruptured intracranial aneurysms.
Main Methods:
- Review of 100 consecutive cases of ruptured intracranial aneurysms.
- Patients received bed rest, sedation, blood pressure control, anticonvulsants, and antifibrinolytic therapy (epsilon aminocaproic acid).
- Microsurgical intervention was performed under hypotensive anesthesia in 86 patients.
Main Results:
- Overall mortality was 15%.
- Surgical mortality was 8.1%, with 6.3% mortality in Grades 1-3 patients.
- Early rebleeding occurred in 11.8% of patients on the medical regimen.
- 60% of patients returned to prior activities; 25% had moderate neurological deficits.
Conclusions:
- Active medical management prior to microsurgical intervention improves overall outcomes for ruptured intracranial aneurysms.
- This integrated approach enhances patient survival and reduces long-term neurological deficits.
Abstract:
The authors review 100 consecutive cases of ruptured intracranial aneurysms to assess the overall morbidity and mortality. Patients were placed on a regimen of bed rest, sedation, control of blood pressure, anticonvulsants, and antifibrinolytic therapy. Surgery was performed on 86 patients with hypotensive anesthesia and microsurgical techniques. The incidence of early rebleeding while on epsilon aminocaproic acid and control of blood pressure was 11.8%. The overall surgical mortality was 8.1%, and the surgical mortality of patients in Grades 1, 2, and 3 was 6.3%. Of the 100 patients, 60 were able to return to their prior activities, and 25 had moderate neurological deficits that required limitation of their activities. The total case mortality was 15%. The evidence presented indicates that the regimen of active medical treatment before microsurgical intervention has improved the overall case morbidity and mortality, as well as the chance for long-term survival.