title: Management and outcomes in a low-volume cerebral aneurysm practice.
abstract: OBJECTIVE
  To review management strategies, outcomes, and complications in cerebral aneurysm surgery in a low-volume aneurysm practice.
  
  
  METHODS
  Seventy-nine craniotomies to treat aneurysms were performed between June 1996 and November 1999. Patient management strategy is outlined, complications are assessed, and outcomes are described.
  
  
  RESULTS
  Twenty-six patients underwent surgery to treat unruptured aneurysms. Forty-two patients presented with Hunt and Hess Grade 1 to 3 subarachnoid hemorrhage. Eleven patients presented with Grade 4 or 5 subarachnoid hemorrhage. Twenty-four patients (92.3%) with unruptured aneurysms experienced favorable outcomes. Of the patients with unruptured anterior circulation aneurysms, 96% achieved favorable recoveries. Thirty-eight patients (90.5%) with Grade 1 to 3 subarachnoid hemorrhage experienced favorable outcomes; four of these patients were moderately disabled. Among patients with Grade 1 to 3 subarachnoid hemorrhage, the mortality rate was 7.1%. Of patients with Grade 4 or 5 subarachnoid hemorrhage, five (45.5%) experienced favorable outcomes, but four of these patients were moderately disabled; two patients (18.2%) were severely disabled, and four patients (36.4%) died.
  
  
  CONCLUSIONS
  Acceptable clinical outcomes can be achieved in lower-volume aneurysm practices. A multidisciplinary subspecialty approach with aggressive perioperative care, especially in the prevention and treatment of cerebral vasospasm, is important in obtaining these results. Close interaction with medical consultants and other subspecialists is necessary.
authors.affiliation: Florence Neurosurgery and Spine, McLeod Regional Medical Center, and Carolinas Hospital System, South Carolina 29506, USA. osanw@msn.com
authors.forename: W B
authors.initials: WB
authors.lastname: Naso
authors.forename: A H
authors.initials: AH
authors.lastname: Rhea
authors.forename: A
authors.initials: A
authors.lastname: Poole
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D002532:Intracranial Aneurysm / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007432:Intraoperative Period; D009493:Neurosurgery; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology