Results of microsurgical management of intracranial aneurysms

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✓ This paper presents the results of a total of 468 aneurysm operations performed on a consecutive series of 463 patients in an 8-year period, using microsurgical techniques. About two-thirds of the patients were operated on within the first 2 weeks after hemorrhage. The postoperative mortality was 4.5%. A good result was obtained in 74.5% of cases, and a fair result in 11.8%, whereas 9.2% were permanently disabled. Hypothermia was used in 142 operations, and 326 were carried out under induced hypotension. Immediate and late results of surgery are discussed with reference to selection of patients, timing of surgery, and the anesthetic and operative procedures.

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Address reprint requests to: Helge Nornes, M.D., Department of Neurosurgery, Rikshospitalet, National Hospital of Norway, Oslo, Norway.

© AANS, except where prohibited by US copyright law.

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References

1.

Albin MSBunegin LDujovny Met al: Brain retraction pressure during intracranial procedures. Surg Forum 26:4995001975Albin MS Bunegin L Dujovny M et al: Brain retraction pressure during intracranial procedures. Surg Forum 26:499–500 1975

2.

Amacher ALFerguson GGDrake CGet al: How old people tolerate intracranial surgery for aneurysm. Neurosurg 1:2422441977Amacher AL Ferguson GG Drake CG et al: How old people tolerate intracranial surgery for aneurysm. Neurosurg 1:242–244 1977

3.

Antunes JLCorrell JW: Cerebral emboli from intracranial aneurysms. Surg Neurol 6:7101976Antunes JL Correll JW: Cerebral emboli from intracranial aneurysms. Surg Neurol 6:7–10 1976

4.

Asari SNakamura SYamado Oet al: Traumatic aneurysm of peripheral cerebral arteries. Report of two cases. J Neurosurg 46:7958031977Asari S Nakamura S Yamado O et al: Traumatic aneurysm of peripheral cerebral arteries. Report of two cases. J Neurosurg 46:795–803 1977

5.

Bergvall UGalera R: Time relationship between subarachnoid haemorrhage, arterial spasm, changes in cerebral circulation and posthaemorrhagic hydrocephalus. Acta Radiol (Diagn) 9:2292371969Bergvall U Galera R: Time relationship between subarachnoid haemorrhage arterial spasm changes in cerebral circulation and posthaemorrhagic hydrocephalus. Acta Radiol (Diagn) 9:229–237 1969

6.

Bohm EHugosson R: Results of surgical treatment of 200 consecutive cerebral arterial aneurysms. Acta Neurol Scand 46:43521970Bohm E Hugosson R: Results of surgical treatment of 200 consecutive cerebral arterial aneurysms. Acta Neurol Scand 46:43–52 1970

7.

Botterell EHLougheed WMScott JWet al: Hypothermia, and interruption of carotid, or carotid and vertebral circulation, in the surgical management of intracranial aneurysms. J Neurosurg 13:1421956Botterell EH Lougheed WM Scott JW et al: Hypothermia and interruption of carotid or carotid and vertebral circulation in the surgical management of intracranial aneurysms. J Neurosurg 13:1–42 1956

8.

Brierley JBCooper JE: Cerebral complications of hypotensive anaesthesia in a healthy adult. J Neurol Neurosurg Psychiatry 25:24301962Brierley JB Cooper JE: Cerebral complications of hypotensive anaesthesia in a healthy adult. J Neurol Neurosurg Psychiatry 25:24–30 1962

9.

Drake CG: Further experience with surgical treatment of aneurysms of the basilar artery. J Neurosurg 29:3723921968Drake CG: Further experience with surgical treatment of aneurysms of the basilar artery. J Neurosurg 29:372–392 1968

10.

Drake CG: Intracranial aneurysms in Tower DB (ed): The Nervous System. The Clinical Neurosciences Volume 2. New York: Raven Press1975 pp 287295Drake CG: Intracranial aneurysms in Tower DB (ed): The Nervous System. The Clinical Neurosciences Volume 2. New York: Raven Press 1975 pp 287–295

11.

Drake CG: The surgical treatment of aneurysms of the basilar artery. J Neurosurg 29:4364461968Drake CG: The surgical treatment of aneurysms of the basilar artery. J Neurosurg 29:436–446 1968

12.

Drake CGVanderlinden RG: The late consequences of incomplete surgical treatment of cerebral aneurysms. J Neurosurg 27:2262381967Drake CG Vanderlinden RG: The late consequences of incomplete surgical treatment of cerebral aneurysms. J Neurosurg 27:226–238 1967

13.

Fisher CMRoberson GHOjemann RG: Cerebral vasospasm with ruptured saccular aneurysm — the clinical manifestations. Neurosurgery 1:2452481977Fisher CM Roberson GH Ojemann RG: Cerebral vasospasm with ruptured saccular aneurysm — the clinical manifestations. Neurosurgery 1:245–248 1977

14.

Galera G-RGreitz T: Hydrocephalus in the adult secondary to the rupture of intracranial arterial aneurysms. J Neurosurg 32:6346411970Galera G-R Greitz T: Hydrocephalus in the adult secondary to the rupture of intracranial arterial aneurysms. J Neurosurg 32:634–641 1970

15.

Hale DECollis JS JrKing MH: Intracranial aneurysmal surgery with and without hypothermia. Surgery 52:3383411962Hale DE Collis JS Jr King MH: Intracranial aneurysmal surgery with and without hypothermia. Surgery 52:338–341 1962

16.

Hamby WB: Multiple intracranial aneurysms. Aspects of treatment. J Neurosurg 16:5585631959Hamby WB: Multiple intracranial aneurysms. Aspects of treatment. J Neurosurg 16:558–563 1959

17.

Hayashi MMarukawa SFujii Het al: Intracranial hypertension in patients with ruptured intracranial aneurysms. J Neurosurg 46:5845901977Hayashi M Marukawa S Fujii H et al: Intracranial hypertension in patients with ruptured intracranial aneurysms. J Neurosurg 46:584–590 1977

18.

Hugosson R: Intracranial arterial aneurysms. Considerations on the upper age limit for surgical treatment. Acta Neurochir 28:1571641973Hugosson R: Intracranial arterial aneurysms. Considerations on the upper age limit for surgical treatment. Acta Neurochir 28:157–164 1973

19.

Hugosson RHögström S: Factors disposing to morbidity in surgery of intracranial aneurysms with special regard to deep controlled hypotension. J Neurosurg 38:5615671973Hugosson R Högström S: Factors disposing to morbidity in surgery of intracranial aneurysms with special regard to deep controlled hypotension. J Neurosurg 38:561–567 1973

20.

Hunt WEHess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14201968Hunt WE Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20 1968

21.

Hunt WEKosnik EV: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79891973Hunt WE Kosnik EV: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79–89 1973

22.

Jain KK: Surgery of intact intracranial aneurysms. J Neurosurg 40:4954981974Jain KK: Surgery of intact intracranial aneurysms. J Neurosurg 40:495–498 1974

23.

Jamieson KG: Aneurysms of the vertebrobasilar system. Surgical intervention in 19 cases. J Neurosurg 21:7817971964Jamieson KG: Aneurysms of the vertebrobasilar system. Surgical intervention in 19 cases. J Neurosurg 21:781–797 1964

24.

Krayenbühl HLüthy F: Hydrozephalus als Spätfolge geplatzter basaler Hirnaneurysmen. Schweiz Arch Neurol Psychiatr 61:7211948Krayenbühl H Lüthy F: Hydrozephalus als Spätfolge geplatzter basaler Hirnaneurysmen. Schweiz Arch Neurol Psychiatr 61:7–21 1948

25.

Krayenbühl HAYaşargil MGFlamm ESet al: Microsurgical treatment of intracranial saccular aneurysms. J Neurosurg 37:6786861972Krayenbühl HA Yaşargil MG Flamm ES et al: Microsurgical treatment of intracranial saccular aneurysms. J Neurosurg 37:678–686 1972

26.

Lougheed WM: The central nervous system in hypothermia. Br Med Bull 17:61651961Lougheed WM: The central nervous system in hypothermia. Br Med Bull 17:61–65 1961

27.

Lougheed WMSweet WHWhite JC: The use of hypothermia in surgical treatment of cerebral vascular lesions. J Neurosurg 12:2402551955Lougheed WM Sweet WH White JC: The use of hypothermia in surgical treatment of cerebral vascular lesions. J Neurosurg 12:240–255 1955

28.

Mayfield FHKees G Jr: A brief history of the development of the Mayfield clip. Technical note. J Neurosurg 35:971001971Mayfield FH Kees G Jr: A brief history of the development of the Mayfield clip. Technical note. J Neurosurg 35:97–100 1971

29.

McDowall DG: The current usage of hypothermia in British neurosurgery. Br J Anaesth 43:108410871971McDowall DG: The current usage of hypothermia in British neurosurgery. Br J Anaesth 43:1084–1087 1971

30.

McKissock WPaine KWEWalsh LS: The value of hypothermia in the surgical treatment of ruptured intracranial aneurysms. J Neurosurg 17:7007071960McKissock W Paine KWE Walsh LS: The value of hypothermia in the surgical treatment of ruptured intracranial aneurysms. J Neurosurg 17:700–707 1960

31.

McKissock WRichardson AWalsh Let al: Multiple intracranial aneurysms. Lancet 1:6236261964McKissock W Richardson A Walsh L et al: Multiple intracranial aneurysms. Lancet 1:623–626 1964

32.

Meyer JSHunter J: Effects of hypothermia on local blood flow and metabolism during cerebral ischemia and hypoxia. J Neurosurg 14:2102271957Meyer JS Hunter J: Effects of hypothermia on local blood flow and metabolism during cerebral ischemia and hypoxia. J Neurosurg 14:210–227 1957

33.

Michenfelder JDTerry HR JrDaw EFet al: Induced hypothermia: physiologic effects, indications and techniques. Surg Clin North Am 45:8898981965Michenfelder JD Terry HR Jr Daw EF et al: Induced hypothermia: physiologic effects indications and techniques. Surg Clin North Am 45:889–898 1965

34.

Mount LABrisman R: Treatment of multiple intracranial aneurysms. J Neurosurg 35:7287301971Mount LA Brisman R: Treatment of multiple intracranial aneurysms. J Neurosurg 35:728–730 1971

35.

Moyes PD: Surgical treatment of multiple aneurysms and of incidentally-discovered unruptured aneurysms. J Neurosurg 35:2912951971Moyes PD: Surgical treatment of multiple aneurysms and of incidentally-discovered unruptured aneurysms. J Neurosurg 35:291–295 1971

36.

Mullan S: Conservative management of the recently ruptured aneurysm. Surg Neurol 3:27321975Mullan S: Conservative management of the recently ruptured aneurysm. Surg Neurol 3:27–32 1975

37.

Mullan SDawley J: Antifibrinolytic therapy for intracranial aneurysms. J Neurosurg 28:21231968Mullan S Dawley J: Antifibrinolytic therapy for intracranial aneurysms. J Neurosurg 28:21–23 1968

38.

Norlén GThulin CA: The use of antifibrinolytic substances in ruptured intracranial aneurysms. Neurochirurgia 12:1001021969Norlén G Thulin CA: The use of antifibrinolytic substances in ruptured intracranial aneurysms. Neurochirurgia 12:100–102 1969

39.

Nornes H: Monitoring of patients with intracranial aneurysms. Clin Neurosurg 22:3213311975Nornes H: Monitoring of patients with intracranial aneurysms. Clin Neurosurg 22:321–331 1975

40.

Nornes H: The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysm. J Neurosurg 39:2262341973Nornes H: The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysm. J Neurosurg 39:226–234 1973

41.

Nornes HKnutzen HBWikeby P: Cerebral arterial blood flow and aneurysm surgery. Part 2: Induced hypotension and autoregulatory capacity. J Neurosurg 47:8198271977Nornes H Knutzen HB Wikeby P: Cerebral arterial blood flow and aneurysm surgery. Part 2: Induced hypotension and autoregulatory capacity. J Neurosurg 47:819–827 1977

42.

Nornes HMagnaes B: Intracranial pressure in patients with ruptured saccular aneurysm. J Neurosurg 36:5375471972Nornes H Magnaes B: Intracranial pressure in patients with ruptured saccular aneurysm. J Neurosurg 36:537–547 1972

43.

Nornes HWikeby P: Cerebral arterial blood flow and aneurysm surgery. Part 1: Local arterial flow dynamics. J Neurosurg 47:8108181977Nornes H Wikeby P: Cerebral arterial blood flow and aneurysm surgery. Part 1: Local arterial flow dynamics. J Neurosurg 47:810–818 1977

44.

Numoto MDonaghy RMP: Effects of local pressure on cortical electrical activity and cortical vessels in the dog. J Neurosurg 33:3813871970Numoto M Donaghy RMP: Effects of local pressure on cortical electrical activity and cortical vessels in the dog. J Neurosurg 33:381–387 1970

45.

Pertuiset Bvan Effenterre RGoutorbe Jet al: Management of aneurysmal rupture during surgery, using bipolar coagulation, deep hypotension, and the operating microscope. Acta Neurochir 30:1952051974Pertuiset B van Effenterre R Goutorbe J et al: Management of aneurysmal rupture during surgery using bipolar coagulation deep hypotension and the operating microscope. Acta Neurochir 30:195–205 1974

46.

Pool JLColton RP: The dissecting microscope for intracranial vascular surgery. J Neurosurg 25:3153181966Pool JL Colton RP: The dissecting microscope for intracranial vascular surgery. J Neurosurg 25:315–318 1966

47.

Pool JLPotts DG: Aneurysms and Arteriovenous Anomalies of the Brain. Diagnosis and Treatment. New York: Hoeber Medical1965463 ppPool JL Potts DG: Aneurysms and Arteriovenous Anomalies of the Brain. Diagnosis and Treatment. New York: Hoeber Medical 1965 463 pp

48.

Rand RW: Microneurosurgery. St. Louis: CV Mosby1969Rand RW: Microneurosurgery. St. Louis: CV Mosby 1969

49.

Rand RWJannetta PJ: Micro-neurosurgery for aneurysms of the vertebral-basilar artery system. J Neurosurg 27:3303351967Rand RW Jannetta PJ: Micro-neurosurgery for aneurysms of the vertebral-basilar artery system. J Neurosurg 27:330–335 1967

50.

Sahs ALPerret GBNishioka H: Intracranial Aneurysms and Subarachnoid Hemorrhage. A Cooperative Study. Philadelphia/Toronto: JB Lippincott1969265 ppSahs AL Perret GB Nishioka H: Intracranial Aneurysms and Subarachnoid Hemorrhage. A Cooperative Study. Philadelphia/Toronto: JB Lippincott 1969 265 pp

51.

Shulman KBoston FMPopoff Net al: Recognition and treatment of hydrocephalus following spontaneous subarachnoid hemorrhage. J Neurosurg 20:104010491963Shulman K Boston FM Popoff N et al: Recognition and treatment of hydrocephalus following spontaneous subarachnoid hemorrhage. J Neurosurg 20:1040–1049 1963

52.

Sugita KHirota TIguchi Iet al: Comparative study of the pressure of various aneurysm clips. J Neurosurg 44:7237271976Sugita K Hirota T Iguchi I et al: Comparative study of the pressure of various aneurysm clips. J Neurosurg 44:723–727 1976

53.

Tovi DNilsson IMThulin C-A: Fibrinolysis and subarachnoid haemorrhage. Inhibitory effect of tranexamic acid. A clinical study. Acta Neurol Scand 48:3934021972Tovi D Nilsson IM Thulin C-A: Fibrinolysis and subarachnoid haemorrhage. Inhibitory effect of tranexamic acid. A clinical study. Acta Neurol Scand 48:393–402 1972

54.

Wiklund PE: Controlled hypotension at intracranial operations. J Neurosurg 10:6176231953Wiklund PE: Controlled hypotension at intracranial operations. J Neurosurg 10:617–623 1953

55.

Yaşargil MGYonekawa YZumstein Bet al: Hydrocephalus following spontaneous subarachnoid hemorrhage. Clinical features and treatment. J Neurosurg 39:4744791973Yaşargil MG Yonekawa Y Zumstein B et al: Hydrocephalus following spontaneous subarachnoid hemorrhage. Clinical features and treatment. J Neurosurg 39:474–479 1973

56.

Yashon DMagness AP IIVise WM: Systemic hypotension in neurosurgery. J Neurosurg 43:5795901975Yashon D Magness AP II Vise WM: Systemic hypotension in neurosurgery. J Neurosurg 43:579–590 1975

57.

Zlotnik EIOleshkevich FVStolkarts JZ: Microsurgical technique in the treatment of intracranial aneurysms. J Neurosurg 46:5915951977Zlotnik EI Oleshkevich FV Stolkarts JZ: Microsurgical technique in the treatment of intracranial aneurysms. J Neurosurg 46:591–595 1977

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