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Prognosis for patients with nonsurgically-treated aneurysms

Analysis of the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage

Carl J. Graf

-day interval, to 7% in the 22- to 28-day interval. There was an unexplained rise to 16% in the 2nd month. The risk then dropped off sharply to 1% or 2% for the third to the twelfth months. The rise in the second month may mean that at this time greater physical activity is assumed and the chance of rebleeding increases. The risk of intracranial operation must be evaluated in terms of a specific aneurysm at a specific site, and at a specific posthemorrhage time. The specific surgeon's technical ability and experience are also important factors. Thus, the risk

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Robert R. Smith and John J. Upchurch

concentration produces its major effect by the inhibition of activation of plasminogen to plasmin, it also has a second and perhaps less potent effect on plasmin itself. Apparently, in very dilute concentrations, EACA enhances the effect of plasmin on the fibrin clot. 1 If this is true, some increase in fibrinolysis may be predicted as therapy is withdrawn. In the treatment of patients with intracranial aneurysms, the value of antifibrinolytic agents will probably be found in the acute treatment phase, a time when the risk factors of intracranial surgery are at their maximum

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Rune Hugosson and Seth Högström

patients (8%) ruptures of varying magnitude occurred at the base of the aneurysm during the hypotensive phase; in 14 of these the hemorrhage was controlled and the ligation was completely satisfactory. The other two patients developed neurological deficits. In 12 patients the aneurysm ruptured before the hypotension had been induced; five of these had neurological deficits and one of them died. Surgical Morbidity and Mortality in the Hypotension Series Risk Factors Present at the Time of Operation The most serious factors leading to morbidity in patients who

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Kenneth J. Rothman and James G. Wepsic

subjects by Gardner, et al. , 4 and Bjerrum and Thornval. 1 In both control series, approximately the same proportion of controls had apices of equal height as did cases of trigeminal neuralgia. Thus, if an elevated petrous ridge is a risk factor in trigeminal neuralgia, it must be a weak one, highly dependent on other influences. This conclusion is consistent with our results, which indicate that the right-sided predominance of the pain in trigeminal neuralgia is a constant finding, not strongly associated with any factor yet identified. Acknowledgments The

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Sean Mullan

suggested that antifibrinolytic treatment supplemented by hypotension could permit most patients to recover without recurrent hemorrhage until the time was right for standard craniotomy and clipping. 3, 5 Treatment by craniotomy in these well-recovered cases carries a very low mortality. For example, we have had no deaths and only one hemiplegia in our last 30 patients. We have concluded that stereotaxic copper electric thrombosis offers a comparable but not a superior risk factor as compared to conservative management plus delayed craniotomy. The technique has the

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Stephen N. Joffe

patients have been studied and the high risk factors assessed, prophylactic measures such as low-dose heparin may play an important role in the postoperative management of the neurosurgical patient. Acknowledgments Thanks are due to Professors J. H. Louw and J. C. de Villiers for their assistance and Dr. J. G. Burger for permission to undertake this study and publish the results. References 1. Browse NL : The 125 I-fibrinogen uptake test. Arch Surg 104 : 160 – 163 , 1972 Browse NL: The 125 I-fibrinogen uptake test

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Charles G. Drake

and cause thrombosis. The stagnant flow within the aneurysm suggests some alteration of hemodynamics within but it is disturbing that the size of the lumen had increased somewhat. An attempt to ligate the smaller vessel in the neck might well have promoted thrombosis of the sac, but the risk factor was considered quite high in view of the effect of even very temporary basilar artery occlusion. Also of great interest is that the first three patients in this group recovered dramatically from brain-stem compression syndromes with thrombosis of the sac; this would

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-pneumonia syndrome” were in fact nonfatal symptomatic pulmonary emboli. This communication is intended to stimulate other clinicians to reexamine their results in a prospective manner using the newer diagnostic procedures and not to accept results formed by clinical impressions. Only in this way can the true incidence in each center be determined, the geography and epidemiology studied, the high-risk factors be assessed, and if routine lung scans were performed, the results correlated with the incidence of DVT and the natural history of pulmonary emboli. If thromboembolism is

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Otmar Gratzl, Peter Schmiedek, Robert Spetzler, Harald Steinhoff and Frank Marguth

intracranial aneurysm. The classification and degree of neurological deficits are summarized in Table 2 . Risk factors associated with ischemic cerebrovascular disease are presented in Table 3 . 6, 12, 17 All the women under 40 years of age among the 65 patients were taking oral contraceptives at the time of their neurological symptoms. There was an average of 3.7 attacks for each of the 10 patients presenting with transient focal cerebral ischemic attacks (TIA) prior to hospitalization. In 19 patients the diagnosis of prolonged reversible ischemic neurological deficits

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Pineal and suprasellar germinomas

Results of radiation treatment

R. Derek T. Jenkin, W. John K. Simpson and Colin W. Keen

suprasellar regions were alive at 5 years. The irradiation of any larger tissue volume can be justified only as an adjuvant treatment to control occult meningeal seeding. Meningeal Seeding Literature review indicated that the risk of meningeal seeding in pineal or suprasellar germinoma was 10% to 15%. 1–3, 5–8, 12–15, 19, 21–23, 26, 28 Based on this risk factor, the known high-cure rate from local irradiation alone, and the morbidity associated with craniospinal irradiation, most authors have favored some form of local irradiation alone unless there was evidence