In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 26, No. 9 ( 1995-09), p. 1553-1557
Abstract:
Background and Purpose The purpose of this study was to determine the causes of morbidity and mortality after surgery for ruptured aneurysms. Methods Two hundred thirty consecutive patients were studied. Initial hemorrhage volume and vasospasm were evaluated preoperatively with CT, transcranial Doppler ultrasonography, and angiography. Nimodipine infusion was started before surgery. Preoperative clinical status was evaluated according to Hunt and Hess grading criteria. Surgery was performed early in 186 patients (81%). Control angiography, transcranial Doppler ultrasonography, and CT were performed routinely after surgery. Hypodense areas revealed by control CT were related to intracerebral initial hematoma, vasospasm, postoperative thrombosis, or spatula hyperpressure. Results Clinical outcome was excellent or good (Glasgow Outcome Scale [GOS] scores of 1 or 2) in 176 patients (77%), 17 (7%) were disabled (GOS score of 3), and 37 (16%) were vegetative or dead. In patients in good condition (grades I to III) preoperatively (n=200), 38 had an unfavorable outcome (GOS score of 2, 3, 4, or 5). The major cause of complication was postoperative thrombosis (42%). In patients in poor condition (grade IV or V) (n=30), 27 had an unfavorable outcome. The major cause of complication was initial bleeding (66%). Vasospasm was responsible for delayed ischemic deficit in 9 patients (3.9% of the total population). Conclusions Systematic angiography remains by far the best means for determining the cause of a poor postoperative course.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/01.STR.26.9.1553
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
1995
detail.hit.zdb_id:
1467823-8
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