Acta neurochirurgica
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Acta neurochirurgica · Aug 2005
Timing of aneurysm surgery in subarachnoid haemorrhage--an observational study in The Netherlands.
There is still lack of evidence on the optimal timing of surgery in patients with aneurysmal subarachnoid haemorrhage. Only one randomised clinical trial has been done, which showed no difference between early and late surgery. Other studies were observational in nature and most had methodological drawbacks that preclude clinically meaningful conclusions. We performed a retrospective observational study on the timing of aneurysm surgery in The Netherlands over a two-year period. ⋯ In this observational study we found no significant difference in outcome between early and late operation for patients in good clinical condition on admission. For patients in poor clinical condition on admission outcome was significantly better after early surgery. The optimal timing of surgery is not yet settled. Ideally, evidence on this issue should come from a randomised clinical trial. However, such a trial or even a prospective study are unlikely to be ever performed because of the rapid development of endovascular coiling.
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Acta neurochirurgica · Aug 2005
Comparative StudyEffect of awake Carotid Endarterectomy under local anaesthesia on peri-operative blood pressure: blood pressure is normalised when carotid stenosis is treated under local anaesthesia.
Carotid Endarterectomy can be performed under local, regional or general anaesthesia. One of the most important effects of the type of anaesthetic used is on the systemic blood pressure. Although variations in blood pressure during and following carotid endarterectomy have been studied previously, the effects of awake carotid endarterectomy under local anaesthesia on blood pressure and its comparison with similar procedures under similar types of anaesthesia have not. ⋯ The study provides evidence about the effect of carotid endarterectomy on the systemic blood pressure and its variations when performed under different types of anaesthesia. There is significant post-operative reduction in both the systolic and diastolic blood pressure values and the intraoperative fluctuation is minimal when local anaesthesia is used. Further studies are required to find out how this affects the long-term blood pressure and clinical outcome of the patient.
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Acta neurochirurgica · Aug 2005
Treatment of wide-necked aneurysms with balloon-expandable polyurethane-covered stentgrafts: experience in an animal model.
Endovascular treatment of intracranial wide-necked aneurysms employing stentgrafts might constitute a promising alternative to established neurosurgical or endovascular treatment options. However, there is uncertainity concerning long-term vessel patency and biocompatibility of the covering material used for these stentgrafts. The objective of our study was, therefore, to evaluate in an animal model of wide necked aneurysms, which changes within the parent vessel wall are present after stentgraft placement using polyurethane as the covering material. ⋯ In previous animal models using Dacron covered stentgrafts, a poor short term patency rate due to the limited biocompatibility was found. We found, that Polyurethane seemed to have less adverse effects upon the vessel wall. However, a longer follow-up period is necessary to exclude delayed stenosis of the parent vessels. Stentgrafts may, therefore, play a role in broad based aneurysms, dissecting aneurysms or pseudoaneurysms, however, vessel sacrifice using permanent balloon occlusion may be a safer and better established alternative compared to the use of stentgrafts.