Aneurismas saculares intracranianos: análise crítica de 456 casos operados

Sampaio, Pedro

doi:10.1590/S0004-282X1984000400003

Resumos

O autor no período de janeiro de 1970 a dezembro de 1983 operou 456 aneurismas intracranianos usando mais das vezes técnicas microcirúrgicas. As topografias mais comuns foram o segmento supraclinóideo da carótida e a artéria comunicante anterior, somando ambas 74,8%. A manifestação clínica dominante correu por conta da hemorragia subaracnóidea, que se situou na faixa de 92%. Preconiza-se a obstrução do colo com clips como tratamento preferido. Quanto à oportunidade cirúrgica pós-hemorragia tem absoluta preferência por operar os casos situados nos graus I e II de Botterell, e após a primeira semana do acidente vascular. A mortalidade foi elevada nos poucos casos operados em estado de coma ou com graves alterações da consciência. A mortalidade em pacientes operados mais tardiamente e em plena higidez física e mental não ultrapassou 2,6%.

From January to December 1983 the author has operated on 456 intracranial aneurysms with microsurgical techniques. Most of them (74.8%) arose from the internal carotid and from the anterior comunicating artey. Subarachnoid hemorrhage was the first occurence in 92% of the patients. The favored technique was occlusion of the neck of the aneurysm with clip. The best surgical results were achieved when the patients were physical and mentally well and were operated on after a week following subarachnoid hemorrhage. The over all mortality was 6.2%.

Aneurismas saculares intracranianos: análise crítica de 456 casos operados

Intracranial saccular aneurysms: critical analysis of 456 operated cases

Pedro Sampaio

Professor Titular de Neurocirurgia e Membro Titular da Academia Nacional de Medicina

RESUMO

O autor no período de janeiro de 1970 a dezembro de 1983 operou 456 aneurismas intracranianos usando mais das vezes técnicas microcirúrgicas. As topografias mais comuns foram o segmento supraclinóideo da carótida e a artéria comunicante anterior, somando ambas 74,8%. A manifestação clínica dominante correu por conta da hemorragia subaracnóidea, que se situou na faixa de 92%. Preconiza-se a obstrução do colo com clips como tratamento preferido. Quanto à oportunidade cirúrgica pós-hemorragia tem absoluta preferência por operar os casos situados nos graus I e II de Botterell, e após a primeira semana do acidente vascular. A mortalidade foi elevada nos poucos casos operados em estado de coma ou com graves alterações da consciência. A mortalidade em pacientes operados mais tardiamente e em plena higidez física e mental não ultrapassou 2,6%.

SUMMARY

From January to December 1983 the author has operated on 456 intracranial aneurysms with microsurgical techniques. Most of them (74.8%) arose from the internal carotid and from the anterior comunicating artey. Subarachnoid hemorrhage was the first occurence in 92% of the patients. The favored technique was occlusion of the neck of the aneurysm with clip. The best surgical results were achieved when the patients were physical and mentally well and were operated on after a week following subarachnoid hemorrhage. The over all mortality was 6.2%.

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Trabalho realizado no Serviço de Neurocirurgia da Universidade Estadual do Rio de Janeiro (UERJ).

R. Venancio Flores 64, apto. 201 - 20000, Rio de Janeiro, RJ - Brasil.

1. ADAMS, H.R.J. - Early management of aneurysmal subarachnoid hemorrhage. A report of the cooperative aneurysm study. J. Neurosurg. 54:141, 1981.
2. BOTTERELL, E.H.; LOUGHEED, W.M.; SCOTT, J.W. & VANDER-VATER, S.H. - Hypothermia and interruption of carotid and vertebral circulation in the surgical management of intracranial aneurysms. J. Neurosurg. 13:1, 1953.
3. JANE, J.A.; "WINN, H.R. & RICHARDSON, A.E. - The natural history of intracranial aneurysms: rebleeding rates during the acute and long-term period and implication for surgical management. Clin. Neurosurg. 24:176, 1977.
4. KASSEL, N.F. & DRAKE, C.G. - Review of the management of saccular aneurysms. Neurologic Clinics 1:73. Saunders, Philadelphia, 1983.
5. KASSEL, N.F. & DRAKE, C.G. - Timing of aneurysms surgery. Neurosurgery 10:515, 1982.
6. LOCKLEY, H.B. - Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage V (part II). J. Neurosurg. 25:321, 1966.
7. Mc CORMICK, W.F. - Problems and Pathogenesis of Intracranial Arterial Aneurysms. Cerebral Vascular Diseases. Ed. John Mossy and Richard Janeway, New York, 1971, pg. 219.
8. PAKARINEN, S. - Incidence, etiology and prognosis of primary subarachnoid hemorrhage: a study based on 589 cases diagnosed in a defined urban population during a defined period. Acta neurol. scand. 43 (Suppl. 29):1, 1967.
9. PHILLIPS, L.H. WHISNANT, J.P. & O'FALLON, W.N. - The unchanging pattern of subarachnoid hemorrhage in a community. Neurology (N.Y.) 30:1034, 1980.
10. SANO, K. - Cerebral vasospasm and aneurysm surgery. Clin. Neurosurg. 30:13, 1983.
11. YASARGIL, M.G. - Microsurgery Applied to Neurosurgery. G. Thieme. New York, 1969, pg. 126.
12. YASARGIL, M.G. - Intracranial microsurgery. Clin. Neurosurg. 17:250, 1969.

Datas de Publicação

Publicação nesta coleção
13 Ago 2012
Data do Fascículo
Dez 1984

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ADAMS, H.R.J. - Early management of aneurysmal subarachnoid hemorrhage. A report of the cooperative aneurysm study. J. Neurosurg. 54:141, 1981.

[2] 2. BOTTERELL, E.H.; LOUGHEED, W.M.; SCOTT, J.W. & VANDER-VATER, S.H. - Hypothermia and interruption of carotid and vertebral circulation in the surgical management of intracranial aneurysms. J. Neurosurg. 13:1, 1953.

[3] 3. JANE, J.A.; "WINN, H.R. & RICHARDSON, A.E. - The natural history of intracranial aneurysms: rebleeding rates during the acute and long-term period and implication for surgical management. Clin. Neurosurg. 24:176, 1977.

[4] 4. KASSEL, N.F. & DRAKE, C.G. - Review of the management of saccular aneurysms. Neurologic Clinics 1:73. Saunders, Philadelphia, 1983.

[5] 5. KASSEL, N.F. & DRAKE, C.G. - Timing of aneurysms surgery. Neurosurgery 10:515, 1982.

[6] 6. LOCKLEY, H.B. - Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage V (part II). J. Neurosurg. 25:321, 1966.

[7] 7. Mc CORMICK, W.F. - Problems and Pathogenesis of Intracranial Arterial Aneurysms. Cerebral Vascular Diseases. Ed. John Mossy and Richard Janeway, New York, 1971, pg. 219.

[8] 8. PAKARINEN, S. - Incidence, etiology and prognosis of primary subarachnoid hemorrhage: a study based on 589 cases diagnosed in a defined urban population during a defined period. Acta neurol. scand. 43 (Suppl. 29):1, 1967.

[9] 9. PHILLIPS, L.H. WHISNANT, J.P. & O'FALLON, W.N. - The unchanging pattern of subarachnoid hemorrhage in a community. Neurology (N.Y.) 30:1034, 1980.

[10] 10. SANO, K. - Cerebral vasospasm and aneurysm surgery. Clin. Neurosurg. 30:13, 1983.

[11] 11. YASARGIL, M.G. - Microsurgery Applied to Neurosurgery. G. Thieme. New York, 1969, pg. 126.

[12] 12. YASARGIL, M.G. - Intracranial microsurgery. Clin. Neurosurg. 17:250, 1969.