Acta neurochirurgica
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Acta neurochirurgica · Jan 1999
Interdisciplinary management results in 100 patients with ruptured and unruptured posterior circulation aneurysms.
The authors report on a series of 100 posterior circulation aneurysms managed by surgical and endovascular procedures. The series consisted of 41 elective admissions more than 14 days after SAH or for unruptured aneurysms and 59 acute admissions after subarachnoid haemorrhage (SAH). In this first interdisciplinary series after the introduction of electrolytically detachable coils, surgical clipping was maintained as treatment of choice in good grade patients while endovascular therapy was primarily offered for patients in poor clinical grade or if the aneurysm was judged difficult to be accessed surgically. ⋯ Size and shape do not appear to be a primary factor to favour one or the other modality. The hope that endovascular therapy improves the prognosis of poor grade patients with posterior circulation aneurysms probably has been overstated. The good results of endovascular treatment with small narrow-necked aneurysms on proximal arteries of the posterior circulation, as seen in the present series and as reported in the accumulating literature, suggest that in future surgical and endovascular treatment should be considered as alternatives in these special cases while in large and broad-necked aneurysms surgery should be considered first.
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Acta neurochirurgica · Jan 1999
Case ReportsRuptured aneurysm at the trunk of the accessory middle cerebral artery.
We present a 32-year-old woman with intracranial haemorrhage due to rupture of a saccular aneurysm arising from the trunk of an accessory middle cerebral artery. This is the first report of an aneurysm arising distally to the anomalous vessel's origin from the A1 segment of the anterior cerebral artery.
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Acta neurochirurgica · Jan 1999
Clinical TrialDissection from fundus to neck for ruptured anterior and middle cerebral artery aneurysms at the acute surgery.
It is generally believed that a ruptured aneurysm should be dissected from its neck to its fundus or that only the neck should be dissected. This study was conducted to clarify whether, during the acute stage, intra-operative bleeding occurs at the same site as the initial rupture point when aneurysms are dissected completely without clipping. The subjects were 170 patients with ruptured anterior or middle cerebral artery aneurysms who were surgically treated by day 7. ⋯ Intra-operative aneurysmal rupture occurred during dissection of the aneurysm itself in 8 patients, during dissection of the artery adhering to the aneurysm in 5 and during clip application in 3. In all the patients whose aneurysms ruptured during aneurysmal dissection, the rupture was caused by injury to the aneurysm and was not directly related to complete exposure of the aneurysm. Intra-operative bleeding did not occur at the same site as the initial rupture point even when the entire aneurysmal complex was dissected from the fundus to the neck without clipping.
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Acta neurochirurgica · Jan 1999
Experimental study of intracisternal administration of tissue-type plasminogen activator followed by cerebrospinal fluid drainage in the ultra-early stage of subarachnoid haemorrhage.
This experimental study evaluated the effect of intrathecal injection of tissue-type plasminogen activator followed by cisternal drainage in the ultra-early stage of aneurysmal subarachnoid haemorrhage to prevent vasospasm. Twenty Japanese white rabbits were divided into five groups. Either tPA (groups A, B, and E) or saline (groups C and D) was injected intrathecally 1 hour (groups A, B, C, and D) or 21 hours (group E) after the intrathecal injection of blood. ⋯ Examination of the series of CSF samples (groups A and C) showed that fibrinolysis with tPA effectively cleared clots early. In the two groups treated with tPA and CSF drainage (groups A and E), early removal of subarachnoid clots reduced the degree of vasospasm. Early fibrinolysis with tPA and early removal of subarachnoid clots by drainage is effective for preventing vasospasm.
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Acta neurochirurgica · Jan 1999
Monitoring of intracranial compliance: correction for a change in body position.
The objectives of our study were 1. to investigate whether the intracranial compliance changes with body position; 2. to test if the pressure-volume index (PVI) calculation is affected by different body positions; 3. to define the optimal parameter to correct PVI for changes in body position and 4. to investigate the physiological meaning of the constant term (P0) in the model of the intracranial volume-pressure relationship. Thirteen patients were included in this study. All patients were subjected to 2 to 3 different body positions. ⋯ Using the constant term P0 to correct the PVI we found no changes between the different body positions. Our results suggest that during the variation in body position there is no change in intracranial compliance but a change in hydrostatic offset pressure which causes a shifting of the volume-pressure curve along the pressure axis without its shape being affected. PVI measurements should either be performed only with the patient in the 0 degree recumbent position or that the PVI calculation should be corrected for the hydrostatic difference between the level of the ICP transducer and the hydrostatic indifference point of the craniospinal system close to the third thoracic vertebra.