title: Intensive care management of patients with severe intracerebral haemorrhage after endovascular treatment of brain arteriovenous malformations.
abstract: We studied the impact of emergency neurosurgery and intensive care on the outcome for patients with severe intracerebral haemorrhage after endovascular treatment of brain arteriovenous malformations (AVMs). We reviewed the case notes of 18 patients with severe haemorrhage after embolisation of a brain AVM between 1986 and 2001. During this period the treatment changed: before 1993, these patients were not surgically treated, and they died, while after 1994, all patients underwent emergency surgery. We established a standardised protocol for emergency treatment and intensive care in May 1998, and emergency surgery was performed as soon as possible after the onset of symptoms of haemorrhage. Postoperative intensive care was according to a standardised regime. During these 15 years, 24 out of 605 patients undergoing 1066 interventions had a haemorrhage during or after the procedure, of which 18 were severe (3% of patients, 1.7% of interventions). All patients had a severe clinical deficit (mean Glasgow coma scale 4.2); eight had uni- or bilateral mydriasis. From 1989 to April 1998 four (31%) of 13 patients died, one (7.5%) remained in a vegetative state and eight (61.5%) made a good recovery. All five patients treated between 1998 and 2001 had a favourable outcome. The mean time from onset of the symptoms of haemorrhage to reaching the operation room was 129 min between 1989 and 1998 and 24 min between 1998 and 2001. Standardised emergency treatment and intensive care with early resuscitation, minimal radiological exploration before rapid surgery improved the outcome. A short time between the onset of the symptoms of haemorrhage and evacuation of the haematoma may be the most important factor for a favourable outcome.
authors.affiliation: Department of Neurosurgery, University Hospital, Nordtrakt 1, Frauenklinikstrasse 10, 8091 Zürich, Switzerland. ees@nch.unizh.ch
authors.forename: E
authors.initials: E
authors.lastname: Keller
authors.forename: Y
authors.initials: Y
authors.lastname: Yonekawa
authors.forename: H G
authors.initials: HG
authors.lastname: Imhof
authors.forename: M
authors.initials: M
authors.lastname: Tanaka
authors.forename: Anton
authors.initials: A
authors.lastname: Valavanis
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000150:complications* / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000628:therapy*; D007427:Intracranial Pressure / Q000502:physiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome