Tratamento cirúrgico de aneurismas intracranianos

Cademartori, Mário S.

doi:10.1590/S0004-282X1988000300008

Resumos

O autor analisa os resultados obtidos pelo tratamento cirúrgico de 325 pacientes com aneurismas intracranianos operados de janeiro de 1979 até dezembro de 1986; 321 pacientes foram tratados por ataque direto dos aneurismas e 4 por ligadura da carótida interna; 122 pacientes tinham aneurismas do sistema carotídeo; 100 apresentavam aneurismas do sistema cerebral anterior; 69, da artéria cerebral média; 4, do sistema vértebro-basilar; 30 apresentavam aneurismas múltiplos. É descrita a rotina pré-operatória adotada e as medidas utilizadas no tratamento das complicações causadas pela hemorragia subaracnóidea. A mortalidade geral foi 16%. Foram revisadas as condições de alta de 279 pacientes. Os resultados foram comparados com os obtidos em 277 casos operados anteriormente pelo autor (1961-1978).

The author reviews his personal experience in the surgical treatment of 325 patients presenting intracranial aneurysms. The patients were operated at Cristo Redentor Hospital between January 1979 and December 1986. Pre and post surgical management of sub-arachnoid haemorrhage and its complications is described. Internal carotid aneurysms were 122; anterior carotid artery, 100; middle cerebral artery, 69; vertebro-basilar system, 4; and multiple aneurysms, 30. 321 of those aneurysms were approached directly. 177 patients Grade I were surgically treated, with a mortality rate of 5.08%; 78 in Grade II with mortality rate of 16.66%; 55 in Grade III with mortality rate of 36.36%; and 15 in Grade IV with mortality rate of 66.6%. The general mortality rate was 16%. The results of surgeries in the former group (1961-1978) of 277 patients were compared to the group of 325 cases. The final mortality rate in 552 operated patients in the two groups is 18.11%.

Mário S. Cademartori

Coordenador do Serviço de Neurocirurgia e da Residência de Neurocirurgia do Hospital Cristo Redentor, Porto Alegre

RESUMO

O autor analisa os resultados obtidos pelo tratamento cirúrgico de 325 pacientes com aneurismas intracranianos operados de janeiro de 1979 até dezembro de 1986; 321 pacientes foram tratados por ataque direto dos aneurismas e 4 por ligadura da carótida interna; 122 pacientes tinham aneurismas do sistema carotídeo; 100 apresentavam aneurismas do sistema cerebral anterior; 69, da artéria cerebral média; 4, do sistema vértebro-basilar; 30 apresentavam aneurismas múltiplos. É descrita a rotina pré-operatória adotada e as medidas utilizadas no tratamento das complicações causadas pela hemorragia subaracnóidea. A mortalidade geral foi 16%. Foram revisadas as condições de alta de 279 pacientes. Os resultados foram comparados com os obtidos em 277 casos operados anteriormente pelo autor (1961-1978).

SUMMARY

The author reviews his personal experience in the surgical treatment of 325 patients presenting intracranial aneurysms. The patients were operated at Cristo Redentor Hospital between January 1979 and December 1986. Pre and post surgical management of sub-arachnoid haemorrhage and its complications is described. Internal carotid aneurysms were 122; anterior carotid artery, 100; middle cerebral artery, 69; vertebro-basilar system, 4; and multiple aneurysms, 30. 321 of those aneurysms were approached directly. 177 patients Grade I were surgically treated, with a mortality rate of 5.08%; 78 in Grade II with mortality rate of 16.66%; 55 in Grade III with mortality rate of 36.36%; and 15 in Grade IV with mortality rate of 66.6%. The general mortality rate was 16%. The results of surgeries in the former group (1961-1978) of 277 patients were compared to the group of 325 cases. The final mortality rate in 552 operated patients in the two groups is 18.11%.

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1. Adams CBT, Loach AB, O'Ladix SS - Intracranial aneurysms: analysis of microneuro-surgery. Brit Med J 2: 607, 1976.
2. Adams H, Kassel NF, Torner JC, Nibbelink DW, Sales AL, - Early management of aneurysmal subarachnoid hemorrhage. J Neurosurg 54: 141, 1981.
3. Allen GS - Prevention of persisting cerebral ischaemic symptoms from cerebral vasospasm with mimodipine. Excerpta Med 111-116, 1983.
4. Barnett HJM - Some clinical features of intracranial aneurysms. Clin Neurosurg 16: 43, 1968.
5. Botterell EH, Lougheed WM, Scott HW, Vandemater SL, - Hypothermia and interruption of carotid, or carotid and vertebral circulation in the surgical management of intracranial aneurysms. J Neurosurg 13: 1, 1956.
6. Cademartori MS - Considerações clinicas e cirúrgicas sobre 115 casos de aneurismas intracranianos. Neurobiologia (Recife) 36: 231, 1970.
7. Cademartori MS, Ferreira NP, Wainer F, Wagner R - Tratamento cirúrgico de aneurismas do sistema cerebral anterior. Arq Neuro Psiquiat (São Paulo) 32: 24, 1974.
8. Cademartori MS - História natural dos aneurismas intracranianos Rev AMRIGS 21: 52,1977.
9. Cademartori MS - Intracranial aneurysms surgery. Seara Med Neuro-Cir 10: 43, 1981.
10. Dell S - Asymptomatic cerebral aneurysm: assessment of its risk of rupture. Neuro-surgery 2 :162, 1982.
11. Dott NM - Intracranial aneurysmal formation. Clin Neurosurgery 16 :1, 1969.
12. Drake, CG - The treatment of aneurysms of the posterior circulation. Clinical Neuro-surgery: Proceedings of the Congress of Neurological Surgeons. Williams & Wilkins, Baltimore, 1979, pg 96.
13. Drebs D - Anestesia em neurorradiologia e neurocirurgia. Rev Bras Anest 6: 463, 1981.
14. Ecker A, Riemenschnider PA - Arteriography demonstration of spasm of the intracranial arteries with especial reference to saccular arterial aneurysms. J Neurosurg 8: 660, 1951.
15. Fischer CM - Clinical syndrome in cerebral thrombosis, hypertensive, hemorrhage and ruptured saccular aneurysms. Clinical Neurosurgery: Proceedings of the Congress of Neurological Surgeons. Williams & Wilkins, Baltimore, 1974, pg 117.
16. Fleischer AS, Tindall GT - Cerebral vasospasm following aneurysm rupture. J Neuro-surg 52 :149, 1980.
17. Glasauer IE - Cerebral aneurysm: surgical treatment NY State J Med 74: 1781, 1974.
18. Graf CJ, Nibbellink DW - Cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Report on a randomized treatment study: III. Intracranial surgery. Stroke 5: 559, 1979.
19. Kassel NF - The natural history and treatment of SAH: comments derived from the national cooperative aneurysm stude. Calcium Antagonists: Possible Therapeutic Use in Neurosurgery. Raven Health Care Communication, New York, 1983, pg 256.
20. Koos WF, Permecaky A, Gaabi MR, Vorkapic P, Mugersböck - Nimodipine in the treatment of symptomatic cerebral vasospasm. Excerpta Med 230-238, 1983.
21. Loksley HB - Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. J Neurosurg 25: 219, 1966.
22. Mizukami M, Kawase T - Prevention of vasospasm by early operation with removal of subarachnoid blood. Neurosurgery 3: 301, 1982.
23. Peerles SY - Pre and post operative management of cerebral aneurysm. Clin Neurosurg 26: 209, 1979.
24. Poppen JC - An Atlas of Neurosurgical Techniques. WB Saunders G, Philadelphia, 1960, pg 161.
25. Samson D, Reyer CW - Furosemid in the preoperative reduction of intracranial pressure in the patient with subarachnoid hemorrhage. Neurosurgery 2: 167, 1982.
26. Sano K - Timing of surgery: the Japonese experience. Calcium Antagonists: Possible Therapeutic Use in Neurosurgery. Raven Health Care Communication, New York, 1983, pg 35.
27. Vang H, Jenkhins JS - Vasopressin in plasma and CSF of patients with subarachnoid hemorrhage. J Neurol Neurosurg Psychiat 44: 216, 1981.
28. Viale GL, Pan A - Carotid choroidal aneurysms: remarks of surgical treatment and autocome. Surg Neurol 11: 141, 1979.
29. Weir B, Aronyk K - Management, mortality and timing of surgery for supratentorial aneurysms. J Neurosurg 54: 146, 1981.
30. Wood J, Snyder LL, Simeone, F - Failure of intravascular volume expansion without hemodilution to elevate cortical blood flow in region of experimental focal ischemia. J Neurosurg 56: 80, 1982.
31. Zervas NT, Candia M, Candia G - Reduced incidence of cerebral ischemia following rupture of intracranial aneurysms. Surg Neurol 11: 339, 1979.

Tratamento cirúrgico de aneurismas intracranianos

Surgical treatment of intracranial aneurysms

Datas de Publicação

Publicação nesta coleção
17 Jun 2011
Data do Fascículo
Set 1988

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

[1] 1. Adams CBT, Loach AB, O'Ladix SS - Intracranial aneurysms: analysis of microneuro-surgery. Brit Med J 2: 607, 1976.

[2] 2. Adams H, Kassel NF, Torner JC, Nibbelink DW, Sales AL, - Early management of aneurysmal subarachnoid hemorrhage. J Neurosurg 54: 141, 1981.

[3] 3. Allen GS - Prevention of persisting cerebral ischaemic symptoms from cerebral vasospasm with mimodipine. Excerpta Med 111-116, 1983.

[4] 4. Barnett HJM - Some clinical features of intracranial aneurysms. Clin Neurosurg 16: 43, 1968.

[5] 5. Botterell EH, Lougheed WM, Scott HW, Vandemater SL, - Hypothermia and interruption of carotid, or carotid and vertebral circulation in the surgical management of intracranial aneurysms. J Neurosurg 13: 1, 1956.

[6] 6. Cademartori MS - Considerações clinicas e cirúrgicas sobre 115 casos de aneurismas intracranianos. Neurobiologia (Recife) 36: 231, 1970.

[7] 7. Cademartori MS, Ferreira NP, Wainer F, Wagner R - Tratamento cirúrgico de aneurismas do sistema cerebral anterior. Arq Neuro Psiquiat (São Paulo) 32: 24, 1974.

[8] 8. Cademartori MS - História natural dos aneurismas intracranianos Rev AMRIGS 21: 52,1977.

[9] 9. Cademartori MS - Intracranial aneurysms surgery. Seara Med Neuro-Cir 10: 43, 1981.

[10] 10. Dell S - Asymptomatic cerebral aneurysm: assessment of its risk of rupture. Neuro-surgery 2 :162, 1982.

[11] 11. Dott NM - Intracranial aneurysmal formation. Clin Neurosurgery 16 :1, 1969.

[12] 12. Drake, CG - The treatment of aneurysms of the posterior circulation. Clinical Neuro-surgery: Proceedings of the Congress of Neurological Surgeons. Williams & Wilkins, Baltimore, 1979, pg 96.

[13] 13. Drebs D - Anestesia em neurorradiologia e neurocirurgia. Rev Bras Anest 6: 463, 1981.

[14] 14. Ecker A, Riemenschnider PA - Arteriography demonstration of spasm of the intracranial arteries with especial reference to saccular arterial aneurysms. J Neurosurg 8: 660, 1951.

[15] 15. Fischer CM - Clinical syndrome in cerebral thrombosis, hypertensive, hemorrhage and ruptured saccular aneurysms. Clinical Neurosurgery: Proceedings of the Congress of Neurological Surgeons. Williams & Wilkins, Baltimore, 1974, pg 117.

[16] 16. Fleischer AS, Tindall GT - Cerebral vasospasm following aneurysm rupture. J Neuro-surg 52 :149, 1980.

[17] 17. Glasauer IE - Cerebral aneurysm: surgical treatment NY State J Med 74: 1781, 1974.

[18] 18. Graf CJ, Nibbellink DW - Cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Report on a randomized treatment study: III. Intracranial surgery. Stroke 5: 559, 1979.

[19] 19. Kassel NF - The natural history and treatment of SAH: comments derived from the national cooperative aneurysm stude. Calcium Antagonists: Possible Therapeutic Use in Neurosurgery. Raven Health Care Communication, New York, 1983, pg 256.

[20] 20. Koos WF, Permecaky A, Gaabi MR, Vorkapic P, Mugersböck - Nimodipine in the treatment of symptomatic cerebral vasospasm. Excerpta Med 230-238, 1983.

[21] 21. Loksley HB - Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. J Neurosurg 25: 219, 1966.

[22] 22. Mizukami M, Kawase T - Prevention of vasospasm by early operation with removal of subarachnoid blood. Neurosurgery 3: 301, 1982.

[23] 23. Peerles SY - Pre and post operative management of cerebral aneurysm. Clin Neurosurg 26: 209, 1979.

[24] 24. Poppen JC - An Atlas of Neurosurgical Techniques. WB Saunders G, Philadelphia, 1960, pg 161.

[25] 25. Samson D, Reyer CW - Furosemid in the preoperative reduction of intracranial pressure in the patient with subarachnoid hemorrhage. Neurosurgery 2: 167, 1982.

[26] 26. Sano K - Timing of surgery: the Japonese experience. Calcium Antagonists: Possible Therapeutic Use in Neurosurgery. Raven Health Care Communication, New York, 1983, pg 35.

[27] 27. Vang H, Jenkhins JS - Vasopressin in plasma and CSF of patients with subarachnoid hemorrhage. J Neurol Neurosurg Psychiat 44: 216, 1981.

[28] 28. Viale GL, Pan A - Carotid choroidal aneurysms: remarks of surgical treatment and autocome. Surg Neurol 11: 141, 1979.

[29] 29. Weir B, Aronyk K - Management, mortality and timing of surgery for supratentorial aneurysms. J Neurosurg 54: 146, 1981.

[30] 30. Wood J, Snyder LL, Simeone, F - Failure of intravascular volume expansion without hemodilution to elevate cortical blood flow in region of experimental focal ischemia. J Neurosurg 56: 80, 1982.

[31] 31. Zervas NT, Candia M, Candia G - Reduced incidence of cerebral ischemia following rupture of intracranial aneurysms. Surg Neurol 11: 339, 1979.