[Indications for surgical therapy of aneurysmic subarachnoid hemorrhage--current status].
The most common cause of spontaneous subarachnoid bleeding (SAB) is a freshly ruptured cerebral aneurysm. The prognosis of an aneurysmal SAB essentially depends on the extent of the bleeding, the sequelae of subsequent vasospasms and the increase in intracranial pressure. Effective measures, such as increasing systemic blood pressure, can only be taken if the aneurysm is eliminated as quickly as possible. However, there are situations in which waiting is indicated. Clipping a cerebral aneurysm is a demanding operation, which requires a high degree of concentration and competence from the entire surgical team. A review of the literature (1990-1996) and a survey of 10 German and 10 international cerebrovascular centers yielded the following update of indications and contraindications for the surgical management of aneurysmal SAB: There is an absolute contraindication for aneurysm clipping in patients over 80 years of age in stage V according to Hunt and Hess and in poor general condition. There is a relative contraindication in patients over 90 years of age no matter what the stage according to Hunt and Hess is, as well as in those over 70 years in stage V according to Hunt and Hess and in poor general condition. Different opinions have been expressed for patients over 70 years in stage V according to Hunt and Hess. The surgical indication is controversial in patients with vasospasm detected by Doppler ultrasonography or by angiography. Emergency aneurysm clipping is performed in the presence of a space-occupying intracranial hematoma. Otherwise, emergency aneurysm elimination is not performed at night in any of the hospitals surveyed, but both angiography and surgery are carried out the next morning in the majority of hospitals. A tired neurosurgeon or surgical team operating at night may constitute a greater risk for the patient than rebleeding. For legal reasons, this aspect was discussed and accepted as another relative contraindication in the annual meeting of the German Neurosurgical Society in Hamburg in 1996.
Pietilä
T A
TA
Neurochirurgischen Universitätsklinik, Freien Universität Berlin, Deutschland.
Hammersen
S
S
Brock
M
M
D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D002546:Ischemic Attack, Transient / Q000601:surgery; D011379:Prognosis; D013345:Subarachnoid Hemorrhage / Q000601:surgery*