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Perioperative Management and Outcome after Surgical Treatment of Anterior Cerebral Artery Aneurysms

Published online by Cambridge University Press:  18 September 2015

Issam A. Awad  and
John R. Little
Issam A. Awad*
Affiliation:
Cerebrovascular Surgery Program, Department of Neurological Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
John R. Little
Affiliation:
Cerebrovascular Surgery Program, Department of Neurological Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
*
Department of Neurological Surgery, Desk S80, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195 U.S.A.
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Abstract:

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The authors present clinical experience with 28 cases of ruptured anterior cerebral artery (ACA) aneurysms managed personally during a 36 month period, and 10 unruptured ACA aneurysms. The cases included five giant aneurysms and four distal ACA aneurysms. Management strategy was uniform and included early operative intervention (except in the setting of deteriorating neurologic deficit, not attributable to hydrocephalus or hematoma), and vasospasm prophylaxis including calcium channel blockers and hypervolemic hemodilution and arterial hypertension. Modern diagnostic adjuncts including transcranial doppler were used as they became available. Good outcome (outcome grade 1 or 2) was observed at 6 months in 71% (20/28) of ruptured cases and in 90% (9/10) of unruptured cases; fair outcome (outcome grade 3) was observed in 14% (4/28) of ruptured cases and in 10% of unruptured cases; bad outcome (outcome grade 4 or 5) was observed in 14% (4/28) of ruptured cases. There were no instances of rebleeding after admission to the hospital. There was a single mortality in a patient moribund on admission. Delayed ischemic deterioration (DID) was documented in 46% (13 of 28) of the ruptured cases, and was a major source of morbidity in 7 of the 9 instances of fair or poor outcome in the series. Management outcome, including the occurrence of subtle neuropsychological difficulties commonly described in cases with ACA aneurysms, is discussed with relation to the incidence of DID, the clinical course of DID, and the possible impact of various therapeutic strategies.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 18 , Issue 2 , May 1991 , pp. 120 - 125
Copyright
Copyright © Canadian Neurological Sciences Federation 1991

References

1.Ausman, JI, Diaz, FG, Malik, GM, et al. Current management of cerebral aneurysms: is it based on facts or myths?. Surg Neurol 1985; 24: 625#x2013;635.CrossRefGoogle ScholarPubMed
2.Kassell, NF, Boarini, DJ, Adams, HB, et al. Overall management of ruptured aneurysms: comparison of early and later operation. Neurosurgery 1981; 9: 120#x2013;128.CrossRefGoogle Scholar
3.Sundt, TM, Whisnant, JP. Subarachnoid hemorrhage from intracranial aneurysms: surgical management and natural history of disease. N Engl J Med 1978; 299: 116#x2013;122.CrossRefGoogle ScholarPubMed
4.Whiting, DM, Barnett, GH, Little, JR. Management of subarchnoid hemorrhage in the critical care unit. Cleve Clin J Med 1989; 56: 775#x2013;785.CrossRefGoogle Scholar
5.Kassell, NF, Saskai, T, Colohan, AR, et al. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 1985; 16: 562#x2013;572.CrossRefGoogle ScholarPubMed
6.Awad, IA, Carter, LP, Spetzler, RF, et al. Clinical vasospasm after subarachnoid hemorrhage: response to hypervolemic hemodilution and arterial hypertension. Stroke 1987; 18: 365#x2013;372.CrossRefGoogle ScholarPubMed
7.Ljunggren, B, Brandt, L, Kagstrom, E, et al. Results of early operations for ruptured aneurysms. J Neurosurg 1981; 54: 473#x2013;479.CrossRefGoogle ScholarPubMed
8.Mizukami, M, Kawase, T, Usami, T, et al. revention of vasospasm by early operation with removal subarchnoid blood. Neurosurgery 1982; 301#x2013;307.CrossRefGoogle Scholar
9.Taneda, M. Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symtoms. J Neurosurg 1982; 57: 622#x2013;628.CrossRefGoogle Scholar
10.Allen, GS, Ahn, HS, Preziosi, TJ, et al. Cerebral arterial spasm: a controlled trial of Nimodipine in patients with subarachnoid hemorrhage. N Engl J Med 1983; 308: 619#x2013;624.CrossRefGoogle ScholarPubMed
11.Kazner, E, Sprung, C, Adelt, D, et al. Clinical experience with Nimodipine in the prophylaxis of neurological deficits after subarachnoid hemorrhage. Neuochirurgia 1985; 28: 110#x2013;113.Google ScholarPubMed
12.Espinosa, F, Weir, B, Overton, T, et al. A randomized placebo-controlled-blind trial of Nimodipine after SAH in monkeys. Part 1 clinical and radiological findings. J Neurosurg 1984; 60: 1167#x2013;1175.CrossRefGoogle Scholar
13.Chyatte, D, Sundt, TM. Cerebral vasospasm after subarachnoid hemorrhage. Mayo Clin Proc 1984; 59: 498#x2013;505.CrossRefGoogle ScholarPubMed
14.Biller, J, Godersky, JC, Adams, HP. Management of aneurysmal subarachnoid hemorrhage. Curr Concepts Cerebrovasc Dis Stroke 1988; 23: 13#x2013;18.Google Scholar
15.Ropper, AH, Zervas, NT. Outcome one year after SAH from cerebral aneurysm. J Neurosurg 1984; 60: 909#x2013;915.CrossRefGoogle ScholarPubMed