Strategies in management of ruptured aneurysms--own experiences with various therapeutical procedures in severe SAH.
A retrospective analysis of 58 patients with spontaneous SAH was conducted. 33 patients suffered on severe SAH, clinical grading IV and V (Hunt, Hess). 11 died without treatment due to decerebrate rigidity. 22 patients were treated, 16 underwent a clipping procedure and 6 were selected for endovascular coilembolization. A total of 14 SAH were associated with intracerebral, intraventricular or subdural hemorrhages. In fact of these in 10 patients first an evacuation of the haematoma or a ventricular drainage was necessary, two times combined with a decompressive craniectomy. In 4 patients the removal of haematoma was combined with clipping of aneurysm in one operation. After occlusion of aneurysm decompressive craniectomy was required in 3 patients, an evacuation of an intracerebral bleeding in 1 patient. 6 patients needed a permanent shunting system. The outcome according the Glasgow Outcome Score was: 4 died (GOS1), 12 were severely disabled (GOS3) and 6 were moderately disabled (GOS4).
Gräwe
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Department of Neurosurgery, Unfallkrankenhaus Berlin. AlexanderG@ukb.de
Meier
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Molsen
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000145:classification / Q000401:mortality / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000401:mortality / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000145:classification / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D013525:Surgical Instruments; D015996:Survival Rate; D014656:Vascular Surgical Procedures