Role of emergency surgery to reduce mortality from rebleed in patients with aneurysmal SAH.

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dc.contributor.authorVarma, Aen_US
dc.contributor.authorMehta, V Sen_US
dc.contributor.authorSingh, V Pen_US
dc.contributor.authorPatir, Ren_US
dc.date.accessioned2000-03-07en_US
dc.date.accessioned2009-06-03T12:43:28Z
dc.date.available2000-03-07en_US
dc.date.available2009-06-03T12:43:28Z
dc.date.issued2000-03-07en_US
dc.description.abstractPotentially salvageable patients with aneurysmal subarachnoid hemorrhage may rebleed and die after admission to a hospital, awaiting an angiogram or surgery. In an attempt to reduce the number of patients thus lost, we are operating on such patients on an emergency basis. This report is a retrospective analysis of patients operated early after aneurysmal SAH, but during routine working hours, versus patients operated on an emergency basis. During an 18 month period 109 patients underwent surgery for intracranial aneurysm. Fifty two (Group 1) patients were subjected to emergency clipping of the aneurysm, and 57 (Group 2) patients underwent early clipping but during routine working hours. There was no selection bias between the two groups. Another 10 patients in Hunt and Hess Grade II and III rebled and died, after admission, awaiting an angiogram or surgery. The overall mortality for the two groups (Grade I to IV) was 11.9%. Mortality in Groups 1 and 2 was 9.6% and 14.0% respectively. At 1 month, good outcome was recorded in 86.6% patients in grade I, 69.2% patients in grade II and 42.8% patients in grade III in group I compared to 68.7% patients in grade I, 80% patients in grade II and 31.5% patients in grade III in group 2. However, the difference was not statistically significant. There was also no significant difference between the incidence of intraoperative brain swelling and delayed ischaemic neurological deficit between the two groups. Grade IV patients had a poor outcome in both the groups. Angiographic vasospasm was associated with poor out come, in either group, in grade IV patients. Patients in Grades I to III should undergo emergency surgery, if the surgeon is experienced and willing to operate at odd hours and necessary support facilities of neuroradiology and neuroanaesthesiology are available. This would avoid deaths in patients awaiting angiograms or surgery.en_US
dc.description.affiliationDepartment of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.en_US
dc.identifier.citationVarma A, Mehta VS, Singh VP, Patir R. Role of emergency surgery to reduce mortality from rebleed in patients with aneurysmal SAH. Neurology India. 2000 Mar; 48(1): 56-62en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/121742
dc.language.isoengen_US
dc.source.urihttps://neurologyindia.comen_US
dc.subject.meshAdolescenten_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAneurysm --complicationsen_US
dc.subject.meshChilden_US
dc.subject.meshChild, Preschoolen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshInfanten_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshSubarachnoid Hemorrhage --etiologyen_US
dc.titleRole of emergency surgery to reduce mortality from rebleed in patients with aneurysmal SAH.en_US
dc.typeClinical Trialen_US
dc.typeJournal Articleen_US
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