Controversies in the surgical treatment of ruptured intracranial aneurysms: the First Annual J. Lawrence Pool Memorial Research Symposium--controversies in the management of cerebral aneurysms.
The management of aneurysmal subarachnoid hemorrhage has evolved over time, including the use of the microscope for aneurysm clip application, improved imaging modalities, endovascular methods for aneurysm treatment, dedicated neurointensive care units, and more aggressive therapy for cerebral vasospasm. Although these advancements have reduced the morbidity and mortality associated with aneurysmal subarachnoid hemorrhage, outcomes for this patient population continue to leave much room for improvement. This work highlights controversial adjuvant techniques, maneuvers, and therapies surrounding the surgical treatment of ruptured cerebral aneurysms that currently lack a consensus opinion. These treatments include centralized care in high-volume centers, as well as the use of antifibrinolytic therapy, routine cerebrospinal fluid diversion, intraoperative hypothermia, temporary clip application, neuroprotective drugs, intraoperative angiography, and decompressive hemicraniectomy. Although definitive answers will only be possible through future multicenter collaboration, we review the controversy surrounding these adjuncts and report the consensus opinion from a highly experienced audience.
Komotar
Ricardo J
RJ
Department of Neurological Surgery, Columbia University, New York, New York 10032, USA. rjk2103@columbia.edu
Zacharia
Brad E
BE
Mocco
J
J
Connolly
E Sander
ES
D017542:Aneurysm, Ruptured / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D002497:Centralized Hospital Services; D002533:Cerebral Angiography; D002557:Cerebrospinal Fluid Shunts; D002986:Clinical Trials as Topic; D006801:Humans; D007036:Hypothermia, Induced; D002532:Intracranial Aneurysm / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D014656:Vascular Surgical Procedures
D000933:Antifibrinolytic Agents