[Ruptured intracranial aneurysm. Modification of the surgical method based on the state of consciousness and age of patients. Personal experience with 468 patients admitted during 2 periods (1972-84 and 1985-89)].
The management of the ruptured intracranial aneurysm (clinical grade I to IV only) is studied in a series including 140 patients admitted from 1985 through 1989, in which selected patients were submitted to early surgery and other patients were postponed for delayed surgery. The results are compared to those of an earlier series including 328 patients admitted from 1972 through 1984, for which the general attitude was the delayed surgery: in the later series; the selection for the timing of surgery was based on two main parameters: the clinical status and the patient's age. When we compare both series, the overall management results demonstrate an improvement of 10% of satisfactory results and a decrease of 10% in the death rate in favour of the later series; for the surgical results, the figures are respectively 6% and 5% in favour of the later series. The relationship between age and outcome shows a considerable improvement: over 50 years of age, we observed plus 25% of satisfactory results and minus 22% in death in favour of the later series. Similarly, the relationship between state of consciousness and outcome, demonstrated a great improvement: for drowsy and stuporous patients the figures are respectively plus 22% and minus 21% in favour of the later series. When we consider the later series alone, the patients were admitted at 4 intervals of time from S.A.H. (D0-3, D4-6, D7-15, D16 and over). The most favorable outcome was observed for those patients admitted late (after D7) and already stabilized.(ABSTRACT TRUNCATED AT 250 WORDS)
Deruty
R
R
Hôpital neurologique, Lyon.
Mottolese
C
C
Pelissou-Guyotat
I
I
Bognar
L
L
Oubouklik
A
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D003243:Consciousness; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D007432:Intraoperative Period; D008722:Methods; D008875:Middle Aged; D012307:Risk Factors; D012422:Rupture, Spontaneous; D012720:Severity of Illness Index; D013997:Time Factors
L'anévrysme intracrânien rompu. Modulation de la chirurgie en fonction de l'état de conscience et de l'age du patient. Expérience personnelle sur 468 patients admis au cours de deux périodes (1972-1984 et 1985-1989).