Cerebral Aneurysms: assessment of 50 cases operated on and comparison with previous series

Borges, Guilherme; Gallani, Nevair Roberti

doi:10.1590/S0004-282X1997000200017

Abstracts

A retrospective analysis of 50 patients who suffered subarachnoid hemorrhage (SAH) treated at UNICAMP between April 1988 and March 1992 is made, distributed as 34% in Hunt & Hess grade 1,38% in grade II, 16% in grade III, and 12% in grade IV. Males were predominant (66.6%), and patients age varied around 47± 12.13 years old. Only 13 patients (26%) were admitted within the first 24 hours after bleeding, with an overall average of 20.45 days of delay. From all cases only one had a rebleeding, survived and was submitted to surgery. Four patients died after surgery (8%). Timing of operation and prognostic chances were available, being 27.30 days after SAH for Hunt & Hess group I. It is analyzed also the timing for diagnosis - which responded for the most delay, and treatment for the other groups, and a historical comparison with previous series since year 1956 of the same Hospital were documented. Good results were observed in 38 cases (76%). The overall results in terms of mortality and morbidity is, in comparison, in accordance with the literature, and is ameliorated from the past series due to technical improvement, despite worsen difficulties in managing admittance, diagnosis and treatment faster, which is required to deal with the disease.

subarachnoid hemorrhage; cerebral aneurysm; cerebral vasospasm

Revisão cirúrgica de 50 pacientes portadores de aneurisma cerebral é realizada. O "timing "cirúrgico e prognóstico é bem documentado e comparado com séries anteriormente publicadas . A demora em se operar os pacientes foi devida à dificuldade de se realizar o diagnóstico (CT e angiografia). Observamos bons resultados em 38 casos (76%) e a taxa de mortalidade foi de 8% (4 casos). Os resultados finais estão, em comparação com a literatura, dentro do aceitável.

hemorragia meníngea; aneurisma cerebral; vasoespasmo

Cerebral Aneurysms: assessment of 50 cases operated on and comparison with previous series

Aneurismas cerebrais: análise de 50 casos operados e comparação com séries anteriores

Guilherme Borges^I; Nevair Roberti Gallani^II

^IChefe do Serviço; Disciplina de Neurocirurgia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP); Professor Doutor

^IIPós-graduando. Serviço de Neurocirurgia da Casa de Saúde Campinas: Neurocirurgião

ABSTRACT

A retrospective analysis of 50 patients who suffered subarachnoid hemorrhage (SAH) treated at UNICAMP between April 1988 and March 1992 is made, distributed as 34% in Hunt & Hess grade 1,38% in grade II, 16% in grade III, and 12% in grade IV. Males were predominant (66.6%), and patients age varied around 47± 12.13 years old. Only 13 patients (26%) were admitted within the first 24 hours after bleeding, with an overall average of 20.45 days of delay. From all cases only one had a rebleeding, survived and was submitted to surgery. Four patients died after surgery (8%). Timing of operation and prognostic chances were available, being 27.30 days after SAH for Hunt & Hess group I. It is analyzed also the timing for diagnosis - which responded for the most delay, and treatment for the other groups, and a historical comparison with previous series since year 1956 of the same Hospital were documented. Good results were observed in 38 cases (76%). The overall results in terms of mortality and morbidity is, in comparison, in accordance with the literature, and is ameliorated from the past series due to technical improvement, despite worsen difficulties in managing admittance, diagnosis and treatment faster, which is required to deal with the disease.

Key words: subarachnoid hemorrhage, cerebral aneurysm, cerebral vasospasm.

RESUMO

Revisão cirúrgica de 50 pacientes portadores de aneurisma cerebral é realizada. O "timing "cirúrgico e prognóstico é bem documentado e comparado com séries anteriormente publicadas . A demora em se operar os pacientes foi devida à dificuldade de se realizar o diagnóstico (CT e angiografia). Observamos bons resultados em 38 casos (76%) e a taxa de mortalidade foi de 8% (4 casos). Os resultados finais estão, em comparação com a literatura, dentro do aceitável.

Palavras-chave: hemorragia meníngea, aneurisma cerebral, vasoespasmo.

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Aceite: 14-janeiro-1997.

Dr. Guilherme Borges - Rua Barão Geraldo de Rezende 282 -13020-440 Campinas SP - Brasil.

1. Allen GS, Ahn HS, Preziosi TJ, Battye R, Boone SC, Chou SN, Kelly Dl, Weir BK, Crabbe RA, Lavik PJ, Rosenbloom SB, Dorsey FC, Ingram CR, Mellits DE, Bertsch LA, Boisvert DPJ, Hundley MB, Johnson RK, Strom JÁ, Transou CR. Cerebral arterial spasm: a controlled trial of nimodipinein patients with subarachnoid hemorrhage. N Engl J Med 1983; 308:619-624.
2. Auer LM. Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. J Neurosurg 1984;15:57-66.
3. Auer LM. Unfavorable outcome following early surgical repair of ruptured cerebral aneurysms: a critical review of238 patients. Surg Neurol 1991;35:152-158.
4. Borges G, Facure NO, Facure JJ. Klinische Wechselbeziehung der Gefaespasmen in der Chirurgie der Aneurysmen. Zent Neurochir 1987;48:219-221.
5. Borges G, Facure NO, Facure JJ. Correlação clínica do vasoespasmo na cirurgiade aneurisma. Arq Bras Neurocirurg 1988;7:29-32.
6. Damasceno BP, Borges G. Acidentes vasculares cerebrais. Rev Bras Med 1991 ;48:72-85.
7. Dei-Anang K, Hey O, Borges G, Schurmann K, Muller W. Management of giant aneurysms. Arq Neuropsiquiatr 1990;48:231 -235.
8. Guglielmi G, Vinuela F, Dulkwiler G, Dion J, Lylyk P, Berenstein A, Strother C, Graves V, Halbach V, Nichols D, Hopkins N, Ferguson R, Septka I. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils.JNeurosurg 1992;77:515-524.
9. Hey O, Dei-Anang K, Borges G, Schurmann K, Muller W. Cerebral aneurysms: assessment of 377 cases (1956-1982). Arq Neuropsiquiatr 1990;48:225-230.
10. Hunt WE, Hess RM. Sur6gical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968;28:14-20.
11. Mandai S, Kinugasa K, OhmotoT. Direct thrombosis of aneurysms with cellulose acetate polymer. J Neurosurg 1992;77:497-500.
12. Meyer FB, Muzzi DA. Cerebral protection during aneurysm surgery with isoflurane anesthesia. J Neurosurg 1992;76:541 -543.
13. Ohman J, Heiskanen O. Effect of nimodipine on the outcome of patients after aneurysmal subarachnoid hemorrhage and surgery. J Neurosurg 1988,69:683-686.
14. Saveland H, Hillman J, Brandt L, Edner G, Jakobsson KE, Algers G. Overall outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 1992;76:729-734.
15. Scievink WI, Piepgras DG, Wirth FP. Rupture of previously documented small asymptomatic saccular intracranial aneurysms. J Neurosurg 1992;76:1019-1024.
16. Suzuki M, Onuma T, Sakurai Y, Mizoi K, Ogawa A, Yoshimoto T. Aneurysms arising from the proximal (A1) segment of the anterior cerebral artery: a study of 38 cases. J Neurosurg 1992;76:455-458.
17. Vermeulen M, Lindsay KW, Murray GD, Cheah F, Hijdra A, Muizelaar JP, Schannong M, Teasdale GM, van Crevel H, van Gijin J. Antifibrinolytic treatment in subarachnoid hemorrhage. N Engl J Med 1984;311:432-437.
18. Wiebers DO, Whisnant JP, O'Fallon M. The natural history of unruptured intracranial aneurysms. N Engl J Med 1981,304:696-698.

Publication Dates

Publication in this collection
10 Nov 2010
Date of issue
June 1997

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

[1] 1. Allen GS, Ahn HS, Preziosi TJ, Battye R, Boone SC, Chou SN, Kelly Dl, Weir BK, Crabbe RA, Lavik PJ, Rosenbloom SB, Dorsey FC, Ingram CR, Mellits DE, Bertsch LA, Boisvert DPJ, Hundley MB, Johnson RK, Strom JÁ, Transou CR. Cerebral arterial spasm: a controlled trial of nimodipinein patients with subarachnoid hemorrhage. N Engl J Med 1983; 308:619-624.

[2] 2. Auer LM. Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. J Neurosurg 1984;15:57-66.

[3] 3. Auer LM. Unfavorable outcome following early surgical repair of ruptured cerebral aneurysms: a critical review of238 patients. Surg Neurol 1991;35:152-158.

[4] 4. Borges G, Facure NO, Facure JJ. Klinische Wechselbeziehung der Gefaespasmen in der Chirurgie der Aneurysmen. Zent Neurochir 1987;48:219-221.

[5] 5. Borges G, Facure NO, Facure JJ. Correlação clínica do vasoespasmo na cirurgiade aneurisma. Arq Bras Neurocirurg 1988;7:29-32.

[6] 6. Damasceno BP, Borges G. Acidentes vasculares cerebrais. Rev Bras Med 1991 ;48:72-85.

[7] 7. Dei-Anang K, Hey O, Borges G, Schurmann K, Muller W. Management of giant aneurysms. Arq Neuropsiquiatr 1990;48:231 -235.

[8] 8. Guglielmi G, Vinuela F, Dulkwiler G, Dion J, Lylyk P, Berenstein A, Strother C, Graves V, Halbach V, Nichols D, Hopkins N, Ferguson R, Septka I. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils.JNeurosurg 1992;77:515-524.

[9] 9. Hey O, Dei-Anang K, Borges G, Schurmann K, Muller W. Cerebral aneurysms: assessment of 377 cases (1956-1982). Arq Neuropsiquiatr 1990;48:225-230.

[10] 10. Hunt WE, Hess RM. Sur6gical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968;28:14-20.

[11] 11. Mandai S, Kinugasa K, OhmotoT. Direct thrombosis of aneurysms with cellulose acetate polymer. J Neurosurg 1992;77:497-500.

[12] 12. Meyer FB, Muzzi DA. Cerebral protection during aneurysm surgery with isoflurane anesthesia. J Neurosurg 1992;76:541 -543.

[13] 13. Ohman J, Heiskanen O. Effect of nimodipine on the outcome of patients after aneurysmal subarachnoid hemorrhage and surgery. J Neurosurg 1988,69:683-686.

[14] 14. Saveland H, Hillman J, Brandt L, Edner G, Jakobsson KE, Algers G. Overall outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 1992;76:729-734.

[15] 15. Scievink WI, Piepgras DG, Wirth FP. Rupture of previously documented small asymptomatic saccular intracranial aneurysms. J Neurosurg 1992;76:1019-1024.

[16] 16. Suzuki M, Onuma T, Sakurai Y, Mizoi K, Ogawa A, Yoshimoto T. Aneurysms arising from the proximal (A1) segment of the anterior cerebral artery: a study of 38 cases. J Neurosurg 1992;76:455-458.

[17] 17. Vermeulen M, Lindsay KW, Murray GD, Cheah F, Hijdra A, Muizelaar JP, Schannong M, Teasdale GM, van Crevel H, van Gijin J. Antifibrinolytic treatment in subarachnoid hemorrhage. N Engl J Med 1984;311:432-437.

[18] 18. Wiebers DO, Whisnant JP, O'Fallon M. The natural history of unruptured intracranial aneurysms. N Engl J Med 1981,304:696-698.