Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study

Restricted access

✓ A total of 216 patients with a ruptured aneurysm of the anterior part of the circle of Willis were enrolled into this prospective randomized study of timing of the operation after aneurysmal subarachnoid hemorrhage (SAH). Only patients in clinical Grades I to III (according to the classification of Hunt and Hess) who were admitted and randomly assigned to a treatment group within 72 hours after the SAH were included in the trial. The patients were randomly assigned to one of three operation groups: acute surgery (AS: 0 to 3 days after the SAH; day of SAH = Day 0), intermediate surgery (IS: 4 to 7 days after the SAH), or late surgery (LS: 8 days to an indefinite time after the SAH). Three patients (4.3%) in the IS group and six patients (8.6%) in the LS group died before surgery was undertaken. At 3 months post-SAH, 65 patients (91.5%) from the AS group were classified as independent compared to 55 (78.6%) from the IS group and 56 (80.0%) from the LS group. The management mortality rate in the AS group was 5.6% compared to 12.9% in the LS group.

Of the 216 patients enrolled in the timing study, 159 were randomly assigned to an independent double-blind placebo-controlled trial of nimodipine in Grade I to III patients. A total of 79 patients received nimodipine and 80 placebo. When the nimodipine group and the no-nimodipine group (the 80 placebo-treated patients plus the 52 patients who were not entered into the nimodipine trial) were analyzed separately, a significant difference was seen in the outcome of the no-nimodipine group (dependent AS vs. dependent IS, p = 0.01). Nimodipine treatment was associated with a significant reduction of delayed ischemic deterioration (all operation groups combined, nimodipine vs. no nimodipine p = 0.01; LS with nimodipine vs. LS with no nimodipine, p = 0.03).

Article Information

Address reprint requests to: Juha Öhman, M.D., Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, SF-00260 Helsinki, Finland.

© AANS, except where prohibited by US copyright law.

Headings

References

1.

Adams HP Jr: Early management of the patient with recent aneurysmal subarachnoid hemorrhage. Stroke 17:106810701987Adams HP Jr: Early management of the patient with recent aneurysmal subarachnoid hemorrhage. Stroke 17:1068–1070 1987

2.

Adams HP JrKassell NFTorner JCet al: Predicting cerebral ischemia after aneurysmal subarachnoid hemorrhage: influences of clinical condition, CT results, and antifibrinolytic therapy. A report of the Cooperative Aneurysm Study. Neurology 37:158615911987Adams HP Jr Kassell NF Torner JC et al: Predicting cerebral ischemia after aneurysmal subarachnoid hemorrhage: influences of clinical condition CT results and antifibrinolytic therapy. A report of the Cooperative Aneurysm Study. Neurology 37:1586–1591 1987

3.

Auer LM: Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery 15:57661984Auer LM: Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery 15:57–66 1984

4.

Ausman JIDiaz FGMalik GMet al: Current management of cerebral aneurysms: is it based on facts or myths? Surg Neurol 24:6256351985Ausman JI Diaz FG Malik GM et al: Current management of cerebral aneurysms: is it based on facts or myths? Surg Neurol 24:625–635 1985

5.

Disney LWeir BPetruk K: Effect on management mortality of a deliberate policy of early operation on supratentorial aneurysms. Neurosurgery 20:6957011987Disney L Weir B Petruk K: Effect on management mortality of a deliberate policy of early operation on supratentorial aneurysms. Neurosurgery 20:695–701 1987

6.

Hugenholz HElgie RG: Considerations in early surgery on good-risk patients with ruptured intracranial aneurysms. J Neurosurg 56:1801851982Hugenholz H Elgie RG: Considerations in early surgery on good-risk patients with ruptured intracranial aneurysms. J Neurosurg 56:180–185 1982

7.

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

8.

Kassell NFBoarini DJAdams HP Jret al: Overall management of ruptured aneurysm: comparison of early and late operation. Neurosurgery 9:1201281981Kassell NF Boarini DJ Adams HP Jr et al: Overall management of ruptured aneurysm: comparison of early and late operation. Neurosurgery 9:120–128 1981

9.

Kassell NFDrake CG: Timing of aneurysm surgery. Neurosurgery 10:5145191982Kassell NF Drake CG: Timing of aneurysm surgery. Neurosurgery 10:514–519 1982

10.

Kassell NFKongable GLTorner JCet al: Delay in referral of patients with ruptured aneurysms to neurosurgical attention. Stroke 16:5875901985Kassell NF Kongable GL Torner JC et al: Delay in referral of patients with ruptured aneurysms to neurosurgical attention. Stroke 16:587–590 1985

11.

Kassell NFTorner JC: Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:4794811983Kassell NF Torner JC: Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:479–481 1983

12.

Kawakami YShimamura Y: Cisternal drainage after early operation of ruptured intracranial aneurysm. Neurosurgery 20:8141987Kawakami Y Shimamura Y: Cisternal drainage after early operation of ruptured intracranial aneurysm. Neurosurgery 20:8–14 1987

13.

Ljunggren BBrandt LKågström Eet al: Results of early operation for ruptured aneurysms. J Neurosurg 54:4734791981Ljunggren B Brandt L Kågström E et al: Results of early operation for ruptured aneurysms. J Neurosurg 54:473–479 1981

14.

Ljunggren BBrandt LSundbärg Get al: Early management of aneurysmal subarachnoid hemorrhage. Neurosurgery 11:4124181982Ljunggren B Brandt L Sundbärg G et al: Early management of aneurysmal subarachnoid hemorrhage. Neurosurgery 11:412–418 1982

15.

Ljunggren BSäveland HBrandt L: Causes of unfavorable outcome after early aneurysm operation. Neurosurgery 13:6296331983Ljunggren B Säveland H Brandt L: Causes of unfavorable outcome after early aneurysm operation. Neurosurgery 13:629–633 1983

16.

Ljunggren BSäveland HBrandt L: Early operation and overall outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 62:5475511985Ljunggren B Säveland H Brandt L: Early operation and overall outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 62:547–551 1985

17.

Milhorat THKrautheim M: Results of early and delayed operations for ruptured intracranial aneurysms in two series of 100 consecutive patients. Surg Neurol 26:1231281986Milhorat TH Krautheim M: Results of early and delayed operations for ruptured intracranial aneurysms in two series of 100 consecutive patients. Surg Neurol 26:123–128 1986

18.

Mizukami MKawase TUsami Tet al: Prevention of vasospasm by early operation with removal of subarachnoid blood. Neurosurgery 10:3013071982Mizukami M Kawase T Usami T et al: Prevention of vasospasm by early operation with removal of subarachnoid blood. Neurosurgery 10:301–307 1982

19.

Norlén G: Some aspects of the surgical treatment of intracranial aneurysms. Neurol Med Chir 7:14271965Norlén G: Some aspects of the surgical treatment of intracranial aneurysms. Neurol Med Chir 7:14–27 1965

20.

Taneda M: Effect of early operation for ruptured aneurysms on prevention of ischemic symptoms. J Neurosurg 57:6226281982Taneda M: Effect of early operation for ruptured aneurysms on prevention of ischemic symptoms. J Neurosurg 57:622–628 1982

21.

Vapalahti MLjunggren BSäveland Het al: Early aneurysm operation and outcome in two remote Scandinavian populations. J Neurosurg 60:116011621984Vapalahti M Ljunggren B Säveland H et al: Early aneurysm operation and outcome in two remote Scandinavian populations. J Neurosurg 60:1160–1162 1984

22.

Vermeulen MLindsay KWMurray GDet al: Antifibrinolytic treatment in subarachnoid hemorrhage. N Engl J Med 311:4324371984Vermeulen M Lindsay KW Murray GD et al: Antifibrinolytic treatment in subarachnoid hemorrhage. N Engl J Med 311:432–437 1984

23.

Weir BAronyk K: Management mortality and the timing of surgery for supratentorial aneurysms. J Neurosurg 54:1461501981Weir B Aronyk K: Management mortality and the timing of surgery for supratentorial aneurysms. J Neurosurg 54:146–150 1981

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 53 53 26
Full Text Views 145 145 15
PDF Downloads 77 77 5
EPUB Downloads 0 0 0

PubMed

Google Scholar