Early transportation, organisation of diagnosis, and operation at the acute stage

Chapters in this book

1. Frontmatter I
2. Introduction V
3. Contents IX
4. The problem of grading scales
5. A Proposal for grading of subarachnoid haemorrhage due to aneurysm rupture 3
6. Standardized clinical grading of patients with subarachnoid haemorrhage: A uniform international system? 9
7. Prognostic factors of ruptured intracranial aneurysms — New clinical grading — 15
8. Computerized tomography
9. Early computed tomography for prediction of vasospasm after aneurysmal rupture: Experience with 364 cases 23
10. Prognostic evaluation of SAH on the basis of computer tomographic findings 33
11. Value of early computed tomography after aneurysm rupture 39
12. Cerebral blood flow
13. Preoperative assessment of cerebrovascular reactivity following subarachnoid haemorrhage - Clinical correlations 47
14. Cerebral blood flow in the prediction of vasospasm after subarachnoid haemorrhage 53
15. Mean cerebral blood flow (m-CBF) and cerebral oxygen utilization (CMRO2) in patients with ruptured intracranial aneurysm in the acute stage 61
16. The usefulness of noninvasive rCBF measurement in the treatment of patients after subarachnoid haemorrhage (SAH). (A 5 years review) 71
17. The negative angiogram
18. Subarachnoid haemorrhage with negative panangiography 81
19. Spontaneous subarachnoid haemorrhage of unknown origin — a prospective study 89
20. Timing of surgery and results
21. Treatment of ruptured intracranial aneurysms at the acute stage — operative timing and results 97
22. Current results and future problems in early aneurysmal surgery 107
23. Early surgery for intracranial aneurysms: influence of clinical and operative findings on final results 115
24. Early surgical management within 72 hours after subarachnoid haemorrhage (185 cases of ruptured intracranial aneurysms) 125
25. Experience in aneurysm surgery: early versus late surgery 133
26. Postoperative course following acute and delayed operation on cerebral aneurysm. A consecutive series of 175 operations 143
27. Timing of operation after subarachnoid haemorrhage since the introduction of CT 153
28. Management mortality related to the timing of surgery for anterior circulation aneurysms 165
29. Results of early surgery for ruptured intracranial aneurysm 177
30. The comatose patients at the acute stage — a surgical taboo? 183
31. Acute subdural haematomas following spontaneous rupture of intracranial aneurysms 195
32. The treatment of intraventricular haemorrhage from ruptured aneurysm 203
33. Large volume SAH — an indication for early surgery 207
34. What does full recovery after acute aneurysm operation mean? A psychological study 211
35. Rate and causes of mortality related to the timing of open surgery in ruptured supratentorial aneurysms (series of 143 cases operated by 5 neurosurgeons) 217
36. Timing of surgery, operative mortality, and follow-up results in cases with subarachnoid haemorrhage due to aneurysm rupture 227
37. Aneurysm surgery on the 4th—7th day after SAH 237
38. Timing of surgery for ruptured cerebral aneurysms 241
39. Timing of operation with regard to four different stages 253
40. Operative outcome as related to time of intervention. Analysis of surgical results in 891 cases of intracranial aneurysm 261
41. Timing of aneurysm surgery from view of a general hospital (review of 330 cases) 267
42. Overall results from 141 "good risk" patients with ruptured cerebral aneurysm submitted to a "delayed surgery" protocol. With a note on "medium level" versus "high level" management 271
43. The international cooperative study on the timing of aneurysm surgery 277
44. Ruptured intracranial aneurysms: A review of our new experience 279
45. Is early operation for ruptured cerebral aneurysm justified? 283
46. Contribution to indications for the operation of intracranial saccular aneurysms at the acute stage 287
47. Surgery of ruptured intracranial aneurysms. Factors influencing the outcome 293
48. Technical aspects of surgical treatment
49. Practical clinical applications of modern physiological concepts in aneurysm surgery 303
50. Intraoperative aneurysm rupture 313
51. Direct surgical approach to infraclinoidal aneurysms 323
52. Acute aneurysm surgery, disturbed CSF-circulation, intracranial pressure and hydrocephalus 331
53. The value of CSF drainage during aneurysm surgery and prevention of the development of hydrocephalus 343
54. Pitfalls in aneurysm surgery — management of aneurysm rupture 349
55. "Scavengery surgery" for subarachnoid haemorrhage (I) — a surgical technique of subarachnoid clot removal 357
56. "Scavengery surgery" for subarachnoid haemorrhage (II) Continuous ventriculo-cisternal perfusion using artificial cerebrospinal fluid with urokinase 365
57. Further trial of cisternal clot removal for severe subarachnoid haemorrhage 373
58. Intermittent versus continuous brain retractor pressure as protective procedure against ischaemic brain cell damage 381
59. The effect of hypotensive agents on regional cerebral blood flow and intracranial pressure in baboons with space occupying lesions 385
60. Diagnosis and timecourse of vasospasm
61. The role of the intracerebral monoamine systems in the development of vasospasm following an experimental subarachnoid haemorrhage 393
62. Serial biochemical changes in the cerebrospinal fluid during the early stage of subarachnoid haemorrhage: relationship with cerebral vasospasm 403
63. Cerebral vasospasm and aneurysm surgery. A review 411
64. Evaluation and prediction of the vasospasm severity following a ruptured supratentorial aneurysm from angiography, clinical grade and somato-sensory evoked potentials 421
65. Correlation of the middle cerebral artery flow velocity with the clinical course and CT-visualized subarachnoid blood in patients after aneurysmal subarachnoid haemorrhage 429
66. Timecourse of cerebrovascular spasm in early aneurysm operation: transcranial Doppler findings 437
67. Course of vasospasm following subarachnoid haemorrhage. Serial angiography, its relation to timing and perioperative care 445
68. Clinical features of cerebral vasospasm following early surgery for intracranial aneurysms 451
69. Is it possible to prevent or to treat vasospasm? 461
70. Prevention and treatment of vasospasm
71. Ca²⁺ homeostasis, Ca²⁺ entry blockers, and brain ischaemia 471
72. The cerebrovascular effect of nimodipine 481
73. Prevention and treatment of vasospasm and cerebral ischaemia after SAH by early surgery and nimodipine 489
74. Acute aneurysm surgery and nimodipine for the prevention of symptomatic vasospasm 493
75. Prevention of delayed ischaemic deficit and improvement of outcome by acute aneurysm surgery and Nimodipine. Analysis of an unselected consecutive series of patients 503
76. Results of early aneurysm operation and intravenous Nimodipine 515
77. Treatment of subarachnoid haemorrhage following aneurysm rupture without specific drug therapy, with antifibrinolytic agents alone and in combination with Nimodipine: a comparative study 523
78. Clinical experiences in the prevention of ischaemic neurological deficits after subarachnoid haemorrhage with Nimodipine 535
79. Report of the Canadian Nimodipine trial examining use of Nimodipine in poor grade aneurysm patients 545
80. Surgical results of ruptured aneurysms related to timing (with special reference to Nimodipine) 551
81. Experiences with Nimodipine in combination with postoperative hypertensive, hypervolemic treatment in the management of ruptured intracranial aneurysms 561
82. Intraarterial treatment of cerebral vasospasm after subarachnoid haemorrhage with Nimodipine 567
83. Appearance of cerebral vasospasm after break of Nimotop-prophylaxis and their treatment (case report) 575
84. Perioperative management regimen of patients with aneurysmal subarachnoid haemorrhage 579
85. Prevention of postoperative vasospasm by cisternal irrigation 587
86. Prevention of delayed ischaemia by radical removoal of subarachnoid clots immediately after rupture of cerebral aneurysms 595
87. Hypervolemic haemodilution therapy for patients with symptomatic vasospasm after early surgery of cerebral aneurysms 601
88. Experimental and clinical study in the use of intrathecal alpha-tocopherol in vasospasm 615
89. Problems of organisation, transport and preoperative management
90. A functioning model of prompt diagnostic management and treatment of SAH due to a ruptured aneurysm 629
91. Early transportation, organisation of diagnosis, and operation at the acute stage 635
92. Experiences on emergency management of SAH during the last thirty years at Cardarelli Hospital - Naples 641
93. From admission to postoperative management 645
94. Risk of rebleeding during angiography in patients with subarachnoid haemorrhage at the peracute stage 653
95. Intra-angiographical aneurysmal rupture as a rare complication of early angiography 657
96. Rebleeding attack of cerebral aneurysms - clinical significance of early aneurysmal rebleeding 665
97. Arterial hypotension following acute aneurysmal subarachnoid haemorrhage 673
98. List of contributors 679
99. Authors index 681
100. Subject index 683