Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 1998
ReviewTemporary vascular occlusion during cerebral aneurysm surgery.
Temporary artery occlusion is an effective way to reduce the detrimental effects of intraoperative aneurysm rupture and to facilitate aneurysm dissection. The major risk incurred is of cerebral infarction. Dilemmas in the use of this technique include the amount of time that arterial flow may be interrupted safely and whether or not there is benefit to intermittent reperfusion. Protocol for the use of temporary occlusion is described.
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Aneurysmal subarachnoid hemorrhage during pregnancy is rare but is an important cause of maternal mortality. Physiologic changes in pregnancy may predispose to aneurysm formation and rupture. ⋯ Unruptured aneurysms should be treated if they are symptomatic or enlarging. Other aneurysms should be treated on an individual basis.
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Traumatic intracranial aneurysms are rare lesions but should be considered in penetrating head injury, particularly in cases of low-velocity gunshot wounds or stab wounds to the head. Because most of these aneurysms are false aneurysms, treatment may require excision or trapping procedures.
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Neurosurg. Clin. N. Am. · Jul 1998
ReviewPerioperative and intensive care unit care of patients with aneurysmal subarachnoid hemorrhage.
Subarachnoid hemorrhage (SAH) is a complex pathophysiological event that results in a number of intracranial and systemic alterations. The effective management of SAH has its foundation in the prevention, early diagnosis, and correction of complications. Successful outcome in these compromised patients requires close monitoring and intensive care. This article will review the pathophysiology of SAH, identify the most common medical and neurological events that complicate SAH, examine the impact of secondary cerebral insults after aneurysm rupture, and outline current ICU care for SAH.
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Cerebral aneurysms and their treatment have numerous consequences for patients and society, including loss of life, permanent neurologic deficits, decreased functioning in daily life, vast expenditures of health care resources, and loss of economic productivity. By the use of administrative, clinical, functional, and economic data, outcomes research increases neuro-surgeons' understanding of aneurysmal disease, and consequently, our ability to provide more effective interventions.