Document Detail

Therapeutic management of grade IV aneurysm patients.
MedLine Citation:
PMID:  8986167     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The timing of surgery in patients suffering from subarachnoid hemorrhage grade IV and V according to Hunt and Hess, is still controversial. Several authors advocate early surgery for patients in poor clinical condition. Improved outcome and decreased mortality rates were reported. Others exclude patients in poor condition from early aneurysm surgery. METHODS: Forty grade IV aneurysm patients were admitted to our department. After ventriculostomy and cerebral angiography, 28 of them were operated on within 72 hours. The postoperative treatment included hypertensive, hypervolemic, hemodilutional therapy (triple-H therapy) and intensive monitoring (intracerebral pressure, blood pressure, hemodynamic parameters). The mean follow-up time was 6 months. RESULTS: Out of the 28 patients who underwent early surgery, 64% were in good health, 11% in poor health, 25% died; there were no survivors in a vegetative state. Twelve patients were treated conservatively; 50% died from infarction and rebleeding, before the operation was performed. Six underwent delayed aneurysm surgery after clinical improvement. In this group, 25% had good clinical outcome. CONCLUSIONS: Our results favor an aggressive treatment of grade IV aneurysm patients by means of ventricular drainage, early surgery and triple-H therapy.
H Gumprecht; R Winkler; W Gerstner; C B Lumenta
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgical neurology     Volume:  47     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-01-23     Completed Date:  1997-01-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  54-8; discussion 58-9     Citation Subset:  IM    
Department of Neurosurgery, Academic Hospital München-Bogenhausen, Munich, Germany.
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MeSH Terms
Glasgow Coma Scale
Intensive Care
Intracranial Aneurysm / complications,  pathology*,  physiopathology,  surgery*,  therapy
Subarachnoid Hemorrhage / etiology,  pathology*,  physiopathology,  surgery*,  therapy
Time Factors
Treatment Outcome

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