Neurosurgery clinics of North America
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Aneurysmal subarachnoid hemorrhage during pregnancy is rare but is an important cause of maternal mortality. Physiologic changes in pregnancy may predispose to aneurysm formation and rupture. ⋯ Unruptured aneurysms should be treated if they are symptomatic or enlarging. Other aneurysms should be treated on an individual basis.
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Traumatic intracranial aneurysms are rare lesions but should be considered in penetrating head injury, particularly in cases of low-velocity gunshot wounds or stab wounds to the head. Because most of these aneurysms are false aneurysms, treatment may require excision or trapping procedures.
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Rupture of cerebral aneurysms is a complex and devastating pathophysiologic event. The successful management of aneurysm rupture requires a dedicated multidisciplinary team. This article reviews pathophysiology; clinical grading that can be used to predict outcome and guide therapy; factors that may affect outcome such as rebleeding, poor clinical grade, intracerebral hemorrhage, intraventricular hemorrhage, and acute hydrocephalus; preoperative care and assessment; pharmacological therapy; anesthetic, surgical, and endovascular considerations; and postoperative care following aneurysm rupture.
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Neurosurg. Clin. N. Am. · Jul 1998
ReviewImaging of intracranial aneurysms and subarachnoid hemorrhage.
Advances in CT, MR imaging, and catheter angiography provide the radiologist and neurosurgeon with a variety of imaging options for screening, diagnosis, presurgical evaluation, and postoperative monitoring of patients with intracranial aneurysms. Noninvasive imaging techniques have not replaced conventional angiography for the comprehensive evaluation o aneurysms but are effective in screening patients suspected to have an unruptured aneurysm or for preoperative planning in emergency situations that preclude catheter angiography. ⋯ Rotational and intraoperative angiography are problem-solving options used for selected cases at our institution. Continuous improvements in techniques for CT and MR angiography may someday reach the point where surgery can be undertaken on the basis on noninvasive imaging alone, with catheter angiography reserved for endovascular therapy planning and guidance.
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Neurosurg. Clin. N. Am. · Jul 1998
ReviewPerioperative and intensive care unit care of patients with aneurysmal subarachnoid hemorrhage.
Subarachnoid hemorrhage (SAH) is a complex pathophysiological event that results in a number of intracranial and systemic alterations. The effective management of SAH has its foundation in the prevention, early diagnosis, and correction of complications. Successful outcome in these compromised patients requires close monitoring and intensive care. This article will review the pathophysiology of SAH, identify the most common medical and neurological events that complicate SAH, examine the impact of secondary cerebral insults after aneurysm rupture, and outline current ICU care for SAH.