Management and Outcomes in a Low-volume Cerebral Aneurysm Practice
| Autor: | William B. Naso, Allen Poole, Andrew H. Rhea |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
medicine.medical_specialty
Subarachnoid hemorrhage medicine.medical_treatment Neurosurgery Subspecialty Disability Evaluation Intraoperative Period Cerebral vasospasm Aneurysm Seizures medicine Humans Vasospasm Intracranial Prospective Studies Practice Patterns Physicians' Craniotomy Aged Cerebral Hemorrhage Retrospective Studies business.industry Vascular disease Mortality rate Intracranial Aneurysm Subarachnoid Hemorrhage medicine.disease Cerebral Angiography Surgery Treatment Outcome Female Neurology (clinical) business Complication Hydrocephalus |
| Zdroj: | Neurosurgery. 48:91-100 |
| ISSN: | 1524-4040 0148-396X |
| DOI: | 10.1097/00006123-200101000-00016 |
| Popis: | OBJECTIVE To review management strategies, outcomes, and complications in cerebral aneurysm surgery in a low-volume aneurysm practice. METHODS Seventy-nine craniotomies to treat aneurysms were performed between June 1996 and November 1999. Patient management strategy is outlined, complications are assessed, and outcomes are described. RESULTS Twenty-six patients underwent surgery to treat unruptured aneurysms. Forty-two patients presented with Hunt and Hess Grade 1 to 3 subarachnoid hemorrhage. Eleven patients presented with Grade 4 or 5 subarachnoid hemorrhage. Twenty-four patients (92.3%) with unruptured aneurysms experienced favorable outcomes. Of the patients with unruptured anterior circulation aneurysms, 96% achieved favorable recoveries. Thirty-eight patients (90.5%) with Grade 1 to 3 subarachnoid hemorrhage experienced favorable outcomes; four of these patients were moderately disabled. Among patients with Grade 1 to 3 subarachnoid hemorrhage, the mortality rate was 7.1%. Of patients with Grade 4 or 5 subarachnoid hemorrhage, five (45.5%) experienced favorable outcomes, but four of these patients were moderately disabled; two patients (18.2%) were severely disabled, and four patients (36.4%) died. CONCLUSION Acceptable clinical outcomes can be achieved in lower-volume aneurysm practices. A multidisciplinary subspecialty approach with aggressive perioperative care, especially in the prevention and treatment of cerebral vasospasm, is important in obtaining these results. Close interaction with medical consultants and other subspecialists is necessary. |
| Databáze: | OpenAIRE |
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