Document Detail

Results of early and delayed operations for ruptured intracranial aneurysms in two series of 100 consecutive patients.
MedLine Citation:
PMID:  3726738     Owner:  NLM     Status:  MEDLINE    
This report compares the results of early and delayed operations for ruptured intracranial aneurysms in two groups of 100 consecutive patients managed at Downstate Medical Center, Brooklyn, N.Y. In the first group, operation was postponed for a minimum of 1 week after subarachnoid hemorrhage, and aneurysmal clipping was carried out only on patients classified as grade I or Ia in whom intracranial pressure was normal, and in whom serial angiograms demonstrated absence or resolution of vasospasm. According to this policy, 35 patients came to operation with no operative deaths (0%) and four permanent neurological deficits (11%). Sixty-five patients died prior to operation from a variety of causes including aneurysmal rebleeding, cerebral vasospasm, and systemic complications. Of 81 patients admitted in grades I-III, the survival rate was 43% (35/81). In the second group, aneurysmal clipping was carried out as soon as possible after admission on all patients who were grade III or below without specific regard to intracranial pressure or angiographic vasospasm, and on occasional grade IV and V patients with intracerebral clots. With this strategy, 81 of 86 grade I-III patients came to surgery. There were 4 operative deaths (4.9%), 10 permanent neurological deficits (12%), and a survival rate of 90% (77/86). Including three of six grade IV and V patients who were successfully operated upon for intracerebral clots, the overall survival of the second group (80%) was more than twice that of the first group (35%). Taken together, these data suggest that, whereas early surgical intervention for ruptured intracranial aneurysms invites a higher operative mortality, patient mortality, by far the most important statistic, can be significantly reduced without increasing long-term morbidity.
T H Milhorat; M Krautheim
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgical neurology     Volume:  26     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  1986 Aug 
Date Detail:
Created Date:  1986-08-08     Completed Date:  1986-08-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  123-8     Citation Subset:  IM    
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MeSH Terms
Intracranial Aneurysm / mortality,  surgery*
Rupture, Spontaneous
Time Factors

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

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