Cerebral aneurysms assessment of 377 cases (1956-1982)

Hey, O.; Dei-Anang, K.; Borges, G.; Schürmann, K.; Müller, W.

doi:10.1590/S0004-282X1990000200015

Abstracts

A review of 177 patients with cerebral aneurysms is made, out of whom 106 with ruptured aneurysms were examined, whose operational timing and prognostic chances were well documented (group B, 1979-1982) and in part updated to 1984. Furthermore, relevant data of a previous series of 200 cases of cerebral aneurysm, treated between 1956-1978 were used (group A). The patients were graded according to Hunt and Hess, assessing the risks involved. The percentages of recurrent bleeding were in group A 36.5% and 28% in group B. The incidence of vasospasm (as seen in angiography) was in group B 39.6% (42/106 patients). The highest rate of vasospasm in the spasm group division B was found to occur in the second and third week after subarachnoid haemorrhage and amounted to 64.7% and 62.5%. A pre-operatively present vasospasm had no negative effects on the mortality rate, but influenced the outcome for the survivors effectively. The total mortality in group A was 22.5% and in group B 11.7%. Timing of the operation among patients in Hunt and Hess-grades I and II needs to discussion. The surgical position of patients in grade V is also certain. What remains to be discussed and needs attention is grade III and patients in grade IVa. Here the time of operative intervention must be planned individually depending on the course of the neurological status.

Os autores apresentam revisão de 177 pacientes com aneurisma observados durante o período de 1979 a 1982 (Grupo B) e dos quais 106 sofreram ruptura aneurismática. É feita comparação com série prévia tratada de 1956 a 1978 (Grupo A), com 20G pacientes. Observou-se a classificação de Hunt e Hess. No Grupo A, 36,5% sofreram ressangramento; no Grupo B, 28%. Vasoespasmo foi observado (angiograficamente) em 42 de 106 pacientes do Grupo B (39,6%). Observou-se ainda que o vasoespasmo ocorreu preponderantemente na segunda e na terceira semanas após o sangramento inicial (64.7% - 62,5%). A presença de vasoespasmo pré-operatório não mostrou efeito negativo quando relacionada ao índice de mortalidade, embora tenha influenciado no prognóstico e na recuperação do paciente. A mortalidade do grupo A foi 22,5% e no grupo B, 11,7%. O «timing» cirúrgico para os pacientes classificados em grau I e grau II (Hunt e Hess) merece ainda discussão. Pacientes em grau III e grau IV merecem atenção especial: a indicação cirúrgica deve ser planejada individualmente, dependendo da evolução do quadro clínico-neurológico.

O. Hey^I; K. Dei-Anang^I; G. Borges^I; K. Schürmann^I; W. Müller^II

^IDepartment of Neurosurgery (Head: Prof. Dr. h.c. K. Schürmann)

^IIDepartment of Neuroradiology Head: Prof. Dr. S. Wende), University Hospital, Mainz (Langenbeckstrasse 1, 6500 Mainz 1, DBR)

SUMMARY

A review of 177 patients with cerebral aneurysms is made, out of whom 106 with ruptured aneurysms were examined, whose operational timing and prognostic chances were well documented (group B, 1979-1982) and in part updated to 1984. Furthermore, relevant data of a previous series of 200 cases of cerebral aneurysm, treated between 1956-1978 were used (group A). The patients were graded according to Hunt and Hess, assessing the risks involved. The percentages of recurrent bleeding were in group A 36.5% and 28% in group B. The incidence of vasospasm (as seen in angiography) was in group B 39.6% (42/106 patients). The highest rate of vasospasm in the spasm group division B was found to occur in the second and third week after subarachnoid haemorrhage and amounted to 64.7% and 62.5%. A pre-operatively present vasospasm had no negative effects on the mortality rate, but influenced the outcome for the survivors effectively. The total mortality in group A was 22.5% and in group B 11.7%. Timing of the operation among patients in Hunt and Hess-grades I and II needs to discussion. The surgical position of patients in grade V is also certain. What remains to be discussed and needs attention is grade III and patients in grade IVa. Here the time of operative intervention must be planned individually depending on the course of the neurological status.

RESUMO

Os autores apresentam revisão de 177 pacientes com aneurisma observados durante o período de 1979 a 1982 (Grupo B) e dos quais 106 sofreram ruptura aneurismática. É feita comparação com série prévia tratada de 1956 a 1978 (Grupo A), com 20G pacientes. Observou-se a classificação de Hunt e Hess. No Grupo A, 36,5% sofreram ressangramento; no Grupo B, 28%. Vasoespasmo foi observado (angiograficamente) em 42 de 106 pacientes do Grupo B (39,6%). Observou-se ainda que o vasoespasmo ocorreu preponderantemente na segunda e na terceira semanas após o sangramento inicial (64.7% - 62,5%). A presença de vasoespasmo pré-operatório não mostrou efeito negativo quando relacionada ao índice de mortalidade, embora tenha influenciado no prognóstico e na recuperação do paciente. A mortalidade do grupo A foi 22,5% e no grupo B, 11,7%. O «timing» cirúrgico para os pacientes classificados em grau I e grau II (Hunt e Hess) merece ainda discussão. Pacientes em grau III e grau IV merecem atenção especial: a indicação cirúrgica deve ser planejada individualmente, dependendo da evolução do quadro clínico-neurológico.

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Dr. Guilherme Borges - Disciplina de Neurocirurgia, Departamento de Neurologia - Faculdade de Ciências Médicas, UNICAMP - Caixa Postal 6111 - 13083 Campinas SP - Brasil

1. Hunt WE, Hess RM - Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14, 1968.
2. Jane JA, Winn HR, Richhardson AE - 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.
3. Jellinger K - Pathology of intracerebral haemorrhage. ZblNeurochir 38:25, 1977.
4. Kassel NF, Tomer JC - Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:479, 1983.
5. Norlen G, Olivecrona H - The treatment of aneurysms of the circle of Willis. J Neurosurg 10:404, 1953.
6. Nornes H - The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysms. J Neurosurg 39:226, 1973.
7. Rosenorn J, Eskesen V, Schmidt K, Ronde F - The risk of rebleeding from ruptured intracranial aneurysms. J Neurosurg 67:329, 1987.
8. Suzuki J. Kodama N, Fuiiwara S - Surgical treatment of internal carotid-posterior communicating aneurysms: from the experience of 213 case3. In Suzuki J - Cerebral Aneurysms. Neuron, Tokyo, 1979, pg 256.
9 WiLkins RH - Attempted prevention of treatment of intracranial arterial spasm: a survey. Neurosurgery 6:198, 1980.
10. Yasargil MG - Microneurosurgery, Volume I. Thieme, Stuttgart, 1984, pg 343.
11. Yasargil MG- Microneurosurgery, Volume II. Thieme, Stuttgart, 1984, pg 7.

Cerebral aneurysms assessment of 377 cases (1956-1982)

Aneurismas cerebrais: conduta em 377 casos (1956-1982)

Publication Dates

Publication in this collection
25 May 2011
Date of issue
June 1990

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

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

[2] 2. Jane JA, Winn HR, Richhardson AE - 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.

[3] 3. Jellinger K - Pathology of intracerebral haemorrhage. ZblNeurochir 38:25, 1977.

[4] 4. Kassel NF, Tomer JC - Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:479, 1983.

[5] 5. Norlen G, Olivecrona H - The treatment of aneurysms of the circle of Willis. J Neurosurg 10:404, 1953.

[6] 6. Nornes H - The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysms. J Neurosurg 39:226, 1973.

[7] 7. Rosenorn J, Eskesen V, Schmidt K, Ronde F - The risk of rebleeding from ruptured intracranial aneurysms. J Neurosurg 67:329, 1987.

[8] 8. Suzuki J. Kodama N, Fuiiwara S - Surgical treatment of internal carotid-posterior communicating aneurysms: from the experience of 213 case3. In Suzuki J - Cerebral Aneurysms. Neuron, Tokyo, 1979, pg 256.

[9] 9 WiLkins RH - Attempted prevention of treatment of intracranial arterial spasm: a survey. Neurosurgery 6:198, 1980.

[10] 10. Yasargil MG - Microneurosurgery, Volume I. Thieme, Stuttgart, 1984, pg 343.

[11] 11. Yasargil MG- Microneurosurgery, Volume II. Thieme, Stuttgart, 1984, pg 7.