Document Detail

Preoperative ventriculostomy and rebleeding after aneurysmal subarachnoid hemorrhage.
MedLine Citation:
PMID:  12452133     Owner:  NLM     Status:  MEDLINE    
OBJECT: Despite the widespread use of ventriculostomy in the treatment of acute hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH), there is no consensus regarding the risk of rebleeding associated with ventriculostomy before aneurysm repair. This present study was conducted to assess the risk of rebleeding after preoperative ventriculostomy in patients with aneurysmal SAH. METHODS: The authors reviewed the records of all patients with acute SAH who were treated at a single institution between 1990 and 1997. Thus, the records of 304 consecutive patients in whom an aneurysmal SAH source was documented on angiographic studies and who had presented to the authors' institution within 7 days of ictus were analyzed. Re-bleeding was confirmed by evidence of recurrent hemorrhage on computerized tomography scans in all cases. Forty-five patients underwent ventriculostomy for acute hydrocephalus after aneurysmal SAH at least 24 hours before aneurysm repair. Ventriculostomy was performed within 24 hours of SAH in 38 patients, within 24 to 48 hours in three patients, and more than 48 hours after SAH in four patients. The mean time interval between SAH and surgery in patients who did not undergo ventriculostomy was no different from the mean interval between ventriculostomy and surgery in patients who underwent preoperative ventriculostomy (3.6 compared with 3.8 days, p = 0.81). Fourteen (5.4%) of the 259 patients who did not undergo ventriculostomy suffered preoperative aneurysm rebleeding, whereas two (4.4%) of the 45 patients who underwent preoperative ventriculostomy had aneurysm rebleeding. CONCLUSIONS: No evidence was found that preoperative ventriculostomy performed after aneurysmal SAH is associated with an increased risk of aneurysm rebleeding when early aneurysm surgery is performed.
Jon I McIver; Jonathan A Friedman; Eelco F M Wijdicks; David G Piepgras; Mark A Pichelmann; L Gerard Toussaint; Robyn L McClelland; Douglas A Nichols; John L D Atkinson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  97     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-11-26     Completed Date:  2002-12-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1042-4     Citation Subset:  AIM; IM    
Departments of Neurologic Surgery, Neurology, Biostatistics, and Radiology, Mayo Clinic, Rochester, Minnesota, USA.
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MeSH Terms
Acute Disease
Aged, 80 and over
Hydrocephalus / etiology*,  surgery*
Intracranial Aneurysm / complications*,  surgery
Middle Aged
Preoperative Care*
Recurrence / prevention & control
Retrospective Studies
Risk Assessment
Subarachnoid Hemorrhage / etiology*
Time Factors
Ventriculostomy* / adverse effects

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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