Tratamento dos aneurismas intracranianos rotos: considerações em torno de 31 casos

Wanderley, Jorge; Pinto, João Teixeira; Melaragno Filho, Roberto

doi:10.1590/S0004-282X1968000400005

Resumos

Foram estudados os 31 primeiros casos de aneurismas intracranianos rôtos internados nos Serviços de Neurologia e Neurocirurgia do Hospital do Servidor Público Estadual de São Paulo. As manifestações clínicas, exames complementares e tratamento são comentados. Onze pacientes foram tratados cirúrgicamente com mortalidade de 27,2% (3 em 11) e 20 receberam tratamento clínico, com mortalidade de 80% (16 em 20). Uma avaliação das classificações de Botterell e col. e McKissock e Walsh para divisão dos pacientes em grupos clínicos mostrou ser a classificação de Botterell um instrumento útil à formulação de um prognóstico para cada caso e eficaz no planejamento terapêutico.

Thirty one cases of intracranial aneurysms are studied and the results of clinical and surgical treatment analized as an initial basis for therapeutic planning in future cases. Operative mortality (3 deaths in 11 operated cases) was 27,2%. Mortality under clinical treatment (16 deaths in 20) was 80%. Clinical grading of patients according to Botterell et al.and McKissock and Walsh has shown that Botterell's classification is a useful tool for prognosis and therapeutic planning in intracranial aneurysms.

Tratamento dos aneurismas intracranianos rotos. Considerações em torno de 31 casos

Treatment of ruptured intracranial aneurysms: a study of 31 cases

Jorge Wanderley^I; João Teixeira Pinto^II; Roberto Melaragno Filho^III

^INeurocirurgião; Serviços de Neurocirurgia e Neurologia do Hospital do Servidor Público Estadual de São Paulo

^IIChefe do Serviço de Neurocirurgia; Hospital do Servidor Público Estadual de São Paulo

^IIIChefe do Serviço de Neurologia; Hospital do Servidor Público Estadual de São Paulo

RESUMO

Foram estudados os 31 primeiros casos de aneurismas intracranianos rôtos internados nos Serviços de Neurologia e Neurocirurgia do Hospital do Servidor Público Estadual de São Paulo. As manifestações clínicas, exames complementares e tratamento são comentados. Onze pacientes foram tratados cirúrgicamente com mortalidade de 27,2% (3 em 11) e 20 receberam tratamento clínico, com mortalidade de 80% (16 em 20). Uma avaliação das classificações de Botterell e col. e McKissock e Walsh para divisão dos pacientes em grupos clínicos mostrou ser a classificação de Botterell um instrumento útil à formulação de um prognóstico para cada caso e eficaz no planejamento terapêutico.

SUMMARY

Thirty one cases of intracranial aneurysms are studied and the results of clinical and surgical treatment analized as an initial basis for therapeutic planning in future cases. Operative mortality (3 deaths in 11 operated cases) was 27,2%. Mortality under clinical treatment (16 deaths in 20) was 80%. Clinical grading of patients according to Botterell et al.and McKissock and Walsh has shown that Botterell's classification is a useful tool for prognosis and therapeutic planning in intracranial aneurysms.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Clínica Neurológica Hospital do Servidor Público Estadual Rua Pedro de Toledo 1800 São Paulo, SP Brasil.

Referências bibliográficas

1. AHMED, R. H. & SEDZIMIR, C. B. Ruptured anterior communicating aneurysms. A comparison of medical and specific surgical treatment. J. Neurosurg. 26:213-217, 1967.
2. ALLCOCK, J. M. & DRAKE, C. G. Ruptured intracranial aneurysms. The role of arterial spasm. J. Neurosurg. 22:21-29, 1965.
3. BOTTERELL, E. H.; LOUGHEED, W. M.; SCOTT, J. W. & VANDERWATER, S. L. Hypothermia and interruption of carotid or carotid and vertebral circulation in the surgical management of intracranial aneurysms. J. Neurosurg. 13:1-14, 1956.
4. BJORKESTEN, G. B. & HALONEN, V. Incidence of intracranial vascular lesions in patients with subarachnoid hemorrhages investigated by four-vessel angiography. J. Neurosurg. 23:29-32, 1965.
5. COOK, A. W.; DOOLEY, D. M. & BROWDER, E. J. Anterior communicating aneurysms: treatment by ligation of an anterior cerebral artery. J. Neurosurg. 23:371-374, 1965.
6. DRAKE, G. C. On the surgical treatment of ruptured intracranial aneurysms. In Clinical Neurosurgery (Proceedings of the congress of Neurological Surgeons, 1965) Editado por J. Shilito Jr. e W. H. Mosberg, vol. 13, pp. 122-152, The Williams & Wilkins Co., Baltimore, 1968.
7. GALLAGHER, J. P. Pilojection for intracranial aneurysms. J. Neurosurg. 21:129-134, 1964.
8. HAMIiY, W. B. Intracranial surgery for aneurysms. Effect of hypothermia upon survival. J. Neurosurg. 20:41-45, 1963.
9. LOGUE, V. Posterior fossa aneurysms. InClinical Neurosurgery (Proceedings of the Congress of Neurological Surgeons, 1963), editado por J. Shilito Jr. e W. H. Mosberg, vol. 11, pp. 183-207, The Williams & Wilkins Co., Baltimore, 1964.
10. MATSON, D. Intracranial arterial aneurysms in childhood. J. Neurosurg. 23:578-583, 1965.
11. MCCORMICK, W. F. & NOFZINGER, J. D. Saccular intracranial aneurysms an autopsy study. J. Neurosurg. 22:155-159, 1965.
12. MCKISSOCK, W. & WALSH, L. Subarachnoid hemorrhage due to intracranial aneurysms. Results of treatment of 249 verified cases. Brit. Med. J. 1:559-565, 1956.
13. MCKISSOCK, W.; RICHARDSON, A. & WALSH, L. Anterior communicating aneurysms. Lancet. 1:873-876, 1965.
14. NISHIOKA, H. Evaluation of the conservative management of ruptured intracranial aneurysms. (Report on the Cooperative Study of intracranial aneurysms and subarachnoid hemorrhage) J. Neurosurg. 25:574-592, 1966.
15. NORLÉN, G. & OLIVECRONA, H. The treatment of aneurysms of the circle of Willis. J. Neurosurg. 10:404-415, 1953.
16. PERRET, G. & NISHIOKA, H. Cerebral angiography. An analysis of the diagnostic value and complications of carotid and vertebral angiography in 5.484 patients. (Report on the Cooperative Study of intracranial aneurysms and subarachnoid hemorrhage) J. Neurosurg. 25:98-114, 1966.
17. POOL, J. L. Timing and techniques in the intracranial surgery of ruptured aneurysms of the anterior communicating artery. J. Neurosurg. 19:378-388, 1962.
18. POOL, J. L. Anterior communicating aneurysms a rebuttal. J. Am. Ass. 195:159-160, 1966.
19. POPPEN, J. L. Operative treatment for aneurysms of the anterior communicating artery. InClinical Neurosurgery (Proceedings of the Congress of Neurological Surgeons, 1963) editado por J. Shilito Jr. e W. H. Mosberg, vol. 11, pp. 8-13, The Williams & Wilkins Co., Baltimore, 1964.
20. RICHARDSON, A. E.; JANE, J. A. & PAYNE, P. M. Assessment of the natural history of anterior communicating aneurysms. J. Neurosurg. 21:266-274, 1964.
21. STORNELLI, S. A. & FRENCH, J. D. Subarachnoid hemorrhage factors in prognosis and management. J. Neurosurg. 21:769-780, 1964.
22. WALTON, J. N. The prognosis and management of subarachnoid haemorrhage. Canad. Med. Ass. J. 72:165-175, 1955.

Datas de Publicação

Publicação nesta coleção
13 Maio 2013
Data do Fascículo
Dez 1968

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

[1] 1. AHMED, R. H. & SEDZIMIR, C. B. Ruptured anterior communicating aneurysms. A comparison of medical and specific surgical treatment. J. Neurosurg. 26:213-217, 1967.

[2] 2. ALLCOCK, J. M. & DRAKE, C. G. Ruptured intracranial aneurysms. The role of arterial spasm. J. Neurosurg. 22:21-29, 1965.

[3] 3. BOTTERELL, E. H.; LOUGHEED, W. M.; SCOTT, J. W. & VANDERWATER, S. L. Hypothermia and interruption of carotid or carotid and vertebral circulation in the surgical management of intracranial aneurysms. J. Neurosurg. 13:1-14, 1956.

[4] 4. BJORKESTEN, G. B. & HALONEN, V. Incidence of intracranial vascular lesions in patients with subarachnoid hemorrhages investigated by four-vessel angiography. J. Neurosurg. 23:29-32, 1965.

[5] 5. COOK, A. W.; DOOLEY, D. M. & BROWDER, E. J. Anterior communicating aneurysms: treatment by ligation of an anterior cerebral artery. J. Neurosurg. 23:371-374, 1965.

[6] 6. DRAKE, G. C. On the surgical treatment of ruptured intracranial aneurysms. In Clinical Neurosurgery (Proceedings of the congress of Neurological Surgeons, 1965) Editado por J. Shilito Jr. e W. H. Mosberg, vol. 13, pp. 122-152, The Williams & Wilkins Co., Baltimore, 1968.

[7] 7. GALLAGHER, J. P. Pilojection for intracranial aneurysms. J. Neurosurg. 21:129-134, 1964.

[8] 8. HAMIiY, W. B. Intracranial surgery for aneurysms. Effect of hypothermia upon survival. J. Neurosurg. 20:41-45, 1963.

[9] 9. LOGUE, V. Posterior fossa aneurysms. InClinical Neurosurgery (Proceedings of the Congress of Neurological Surgeons, 1963), editado por J. Shilito Jr. e W. H. Mosberg, vol. 11, pp. 183-207, The Williams & Wilkins Co., Baltimore, 1964.

[10] 10. MATSON, D. Intracranial arterial aneurysms in childhood. J. Neurosurg. 23:578-583, 1965.

[11] 11. MCCORMICK, W. F. & NOFZINGER, J. D. Saccular intracranial aneurysms an autopsy study. J. Neurosurg. 22:155-159, 1965.

[12] 12. MCKISSOCK, W. & WALSH, L. Subarachnoid hemorrhage due to intracranial aneurysms. Results of treatment of 249 verified cases. Brit. Med. J. 1:559-565, 1956.

[13] 13. MCKISSOCK, W.; RICHARDSON, A. & WALSH, L. Anterior communicating aneurysms. Lancet. 1:873-876, 1965.

[14] 14. NISHIOKA, H. Evaluation of the conservative management of ruptured intracranial aneurysms. (Report on the Cooperative Study of intracranial aneurysms and subarachnoid hemorrhage) J. Neurosurg. 25:574-592, 1966.

[15] 15. NORLÉN, G. & OLIVECRONA, H. The treatment of aneurysms of the circle of Willis. J. Neurosurg. 10:404-415, 1953.

[16] 16. PERRET, G. & NISHIOKA, H. Cerebral angiography. An analysis of the diagnostic value and complications of carotid and vertebral angiography in 5.484 patients. (Report on the Cooperative Study of intracranial aneurysms and subarachnoid hemorrhage) J. Neurosurg. 25:98-114, 1966.

[17] 17. POOL, J. L. Timing and techniques in the intracranial surgery of ruptured aneurysms of the anterior communicating artery. J. Neurosurg. 19:378-388, 1962.

[18] 18. POOL, J. L. Anterior communicating aneurysms a rebuttal. J. Am. Ass. 195:159-160, 1966.

[19] 19. POPPEN, J. L. Operative treatment for aneurysms of the anterior communicating artery. InClinical Neurosurgery (Proceedings of the Congress of Neurological Surgeons, 1963) editado por J. Shilito Jr. e W. H. Mosberg, vol. 11, pp. 8-13, The Williams & Wilkins Co., Baltimore, 1964.

[20] 20. RICHARDSON, A. E.; JANE, J. A. & PAYNE, P. M. Assessment of the natural history of anterior communicating aneurysms. J. Neurosurg. 21:266-274, 1964.

[21] 21. STORNELLI, S. A. & FRENCH, J. D. Subarachnoid hemorrhage factors in prognosis and management. J. Neurosurg. 21:769-780, 1964.

[22] 22. WALTON, J. N. The prognosis and management of subarachnoid haemorrhage. Canad. Med. Ass. J. 72:165-175, 1955.