Document Detail

Emergent aneurysm surgery without cerebral angiography for the comatose patient.
MedLine Citation:
PMID:  1997899     Owner:  NLM     Status:  MEDLINE    
Neurologically based clinical grading scales offer excellent prognostic information for the patient suffering diffuse subarachnoid hemorrhage (SAH). These grading scales are less applicable to patients with life-threatening intraparenchymal hematomas after aneurysmal rupture. During the last 3 years, four patients in a comatose state with brain stem compression syndromes documented by computed tomographic scans have undergone emergent operation in our neurosurgical service. Each patient was so critically ill that we believed it unwise to delay craniotomy for diagnostic angiography. The average delay from the onset of coma to skin incision was 3.02 hours (range, 1.67-6.5 hours), and the average delay from arrival in our unit until skin incision was 1.8 hours (range, 0.75-2.5 hours). The condition of two arousable patients deteriorated while they were in the emergency room, presumably from new bleeding. Each patient underwent craniotomy for hematoma evacuation, definitive aneurysm clipping, and lobectomy for decompression. Temporary clipping was employed in one patient, and intraoperative rupture occurred in two others. Three patients survived but retain significant disability. Emergent craniotomy with empiric exploration of appropriate subarachnoid cisterns after hematoma decompression may be life-saving in some cases. The delay imposed for diagnostic angiography may be avoided in attempts to save vital minutes of severe brain stem compression.
H H Batjer; D S Samson
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  28     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  1991 Feb 
Date Detail:
Created Date:  1991-04-01     Completed Date:  1991-04-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  283-7     Citation Subset:  IM    
Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas.
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MeSH Terms
Ambulatory Care
Cerebral Angiography*
Coma / surgery*
Intracranial Aneurysm / radiography,  surgery*
Middle Aged
Subarachnoid Hemorrhage / radiography,  surgery*
Tomography, X-Ray Computed
Comment In:
Neurosurgery. 1991 Jun;28(6):930-1   [PMID:  2067624 ]

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