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  • subarachnoid haemorrhage  (116)
  • outcome  (49)
  • 1
    Keywords: SURVIVAL ; tumor ; THERAPY ; FOLLOW-UP ; LONG-TERM ; SURGERY ; PATIENT ; IMPACT ; RESECTION ; GLIOMAS ; MANAGEMENT ; ADULT ; REGRESSION ; THERAPIES ; GLIOMA ; methods ; LONG ; LOW-GRADE GLIOMA ; multivariate analysis ; EXTENT ; surgical resection ; LOW-GRADE ; PROGRESSION-FREE SURVIVAL ; outcome ; Low grade gliomas ; A ; randomized studies
    Abstract: Purpose: The appropriate management of low-grade gliomas is still a matter of debate. So far, there are no randomized studies that analyze the impact of surgical resection on patient outcome. The value of the data obtained from the few retrospective reports available is often limited. Patients and methods: In the present study, we performed an analysis on data of 130 adult low-grade glioma patients. Extent of the resection was evaluated in correlation to the overall survival (OS) and progression-free survival (PFS) using Cox regression multivariate analysis. Results: Extended surgery was shown to prolong OS and PFS significantly. Re-surgery in the case of a tumor relapse has a significant impact on OS and PFS, too. Conclusions: In summary, we could retrospectively evaluate a large case series of well-defined low-grade gliomas patients with a long follow-up period showing that extended surgery would be the most effective therapy for low-grade glioma patients even in recurrent diseases.
    Type of Publication: Journal article published
    PubMed ID: 19730773
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  • 2
    ISSN: 0942-0940
    Keywords: Brain contusion ; contusion volume ; quantitative assessment, CT ; CSF-CKBB clearance ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In order to evaluate if it is practically possible to assess the volume of contused brain tissue from the CT pictures, a comparison has been carried out between the size of the cerebral contusion(s)-as estimated from the CT scans-and the post-traumatic CSF-CKBB activity, in a series of 29 patients with severe head injury. A clearance curve for the elimination of CKBB from the CSF was constructed. The relation between contusion volume and CSF-CKBB-activity was not statistically significant, while the relationships between contusion volume and outcome, and between CSF-CKBB, as estimated at 6 hours after trauma from the clearance curve, and outcome, were.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 0942-0940
    Keywords: Aneurysm rupture ; subarachnoid haemorrhage ; grade IV and V patients ; early aneurysm surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a retrospective study the clinical management of 74 patients with aneurysmal subarachnoid haemorrhage (SAH) admitted in grade IV and V Hunt and Hess was examined. 39 patients (53%) were admitted within 24 hours after SAH, 29 patients (39%) between 24 and 72 hours after SAH, and 6 patients 8%) later than this time interval. The ruptured aneurysms were located at the anterior communicating artery complex in 34 patients (46%), on the middle cerebral artery in 19 patients (26%), on the internal carotid artery in 12 patients (16%) and at the vertebro-basilar artery complex in 9 patients (12%). In 38 patients (51%) no surgical attack on the aneurysm was performed. 19 (50%) of these patients were in grade IV on admission and 19 (50%) in grade V. In 36 patients (49%) the aneurysm was clipped. Of these patients 29 (81%) were in grade IV and 7 (19%) in grade V. Of the 38 patients in whom no aneurysm surgery was done, 37 patients died, representing a mortality rate of 97%, one patient survived in grade III Glasgow Outcome Scale (GOS). Concerning the outcome in those patients with aneurysm clipping, of 19 patients in grade IV operated on early, 10 patients (53%) made a good recovery, 3 (16%) were left severely disabled and 6 patients (31%) remained in a vegetative state or died. Of the 10 patients in grade IV with delayed surgery 4 (40%) were in grade I and II postoperatively, 2 (20%) in grade III, and again 4 (40%) in grade IV and V GOS. None of the 4 patients in Hunt and Hess grade V in whom early surgery was done achieved a good postoperative outcome. 2 patients survived in grade III GOS, and another 2 patients died. Only three patients admitted in grade V survived long enough to be subjected to delayed surgery. Of these patients one survived without deficit, one survived severely disabled and one patient died. From the data presented the following conclusions are drawn: 1. Without surgery the chance of survival in poor-grade aneurysm patients is almost non existent 2. Patients admitted in grade V have a uniformly poor prognosis with a very high mortality whether surgery is done or not, and whether surgery is performed early or late. 3. Patients in grade IV represent a distinct group with a better prognosis than those in grade V, justifying an aggressive surgical management. 4. Early surgery in grade IV patients leads to better results than delayed surgery especially in terms of overall management morbidity and mortality. 5. In order to further improve the results of management of poor-grade aneurysm patients early referral to neurosurgical centres is mandatory.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 0942-0940
    Keywords: Electroencephalogram (EEG) ; subarachnoid haemorrhage ; aneurysm ; vasospasm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The Electroencephalogram (EEG) of 151 patients whose ruptured aneurysm was confirmed by CT scan and angiography was recorded on the first day (D1) and the fifth day (D5). On D1, EEG had a prognostic value: among 46 patients with normal EEG, 72% presented neither further electrical ischaemic features nor delayed angiographic vasospasm; on the other hand, when bilateral bursts of slow waves, “axial bursts” or slow delta waves were recorded (78 cases), 97% exhibited EEG signs of ischaemia and angiographic vasospasm a few days later. These data were clearly related to the importance of the haemorrhage, specially when thick clots in the subarachnoid cisterns were found on the CT scan. On D5, EEG had a diagnostic value: focal or asymetrical bilateral delta waves occuring at that date seemed to correspond to ischaemia; among 107 patients with these electrical features, an angiographic vasospasm appeared in 96% of cases, and the importance of electrical abnormalities could be related to the degree of arterial narrowing. We conclude that EEG data are very useful in prediction as well in recognition of post-subarachnoid haemorrhage ischaemia due to vasospasm and are sufficiently precise to postpone control angiography and operation, when delayed surgery is programmed.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 0942-0940
    Keywords: Intracerebral haemorrhage ; meningioma ; subarachnoid haemorrhage ; subdural haematoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Classically meningiomas present and evolve with a progressive course. Meningiomas manifest themselves mainly in middle and old age when the incidence of strokes is higher. The authors report three instances of meningioma with acute haemorrhagic onset. The clinical picture of our cases consisted of subarachnoid bleeding, subdural heamatoma and intracerebral haemorrhage respectively. The diagnostic difficulties encountered when assessing these patients are discussed. The current literature regarding meningioma associated with haemorrhage is reviewed. One of our cases seems to be the fisrt reported case of subarachnoid haemorrhage originating from a meningioma of the petrous bone.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 0942-0940
    Keywords: Aneurysm ; subarachnoid haemorrhage ; timing of surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The management of the ruptured intracranial aneurysm is studied in two consecutive series: an earlier series, including 328 patients admitted from 1972 through 1984, for which the general attitude was delayed surgery, and a later series, including 140 patients admitted from 1985 through 1989, in which selected patients were submitted to early surgery and other patients were postponed for delayed surgery, according to two main parameters: the clinical status and the patient's age. When we compare both series, the overall management results demonstrate an improvement of 10% of satisfactory results and a decrease of 10% in the death rate in favour of the later series; for the surgical results, the figures are respectively 6% and 5% in favour of the later series. The relationship between age and outcome shows a considerable improvement: over 50 years of age, we observed plus 25% of satisfactory results and minus 22% in death in favour of the later series. Similarly the relationship between state of consciousness and outcome, demonstrated a great improvement; for drowsy and stuporous patients the figures are respectively plus 22% and minus 21% in favour of the later series. When we consider the later series alone, the patients were admitted at 4 intervals of time from SAH (D0-3, D4-6, D7-15, D16 and over). The most favourable outcome was observed for those patients admitted late (after D7) and already stabilized. Patients admitted early (D0-3) were operated on at four intervals of time (D0-3, D4-6, D7-15, D16 and over). The most favourable outcome was observed for those patients operated on early (D0-3) or very late (D16 and over). For patients admitted early and being under 50 years of age, the results were: satisfactory 92%, poor 2.5%, death 5%. The relationship between age and outcome shows a very small difference between patients under or over 50 years of age. The relationship between level of consciousness and outcome still demonstrates an appreciable difference: plus 22% (satisfactory) and minus 7% (death) in favour of alert patients. Rebleeding was the cause of disability or death in 2.8% of the overall later series and 2.7% of patients admitted early; as for vasospasm the figures are respectively 4.2% and 5.4%. These results are presented with reference to those of the Co-operative Study. After this experience, the author's general attitude for the timing of surgery is neither systematic early surgery, nor systematic delayed surgery, but modulated surgery, based upon the evaluation of the operative risk: minor risk, major risk, intermediate risk. Schematically the authors propose: early surgery in alert patients and under 50 years of age (minor risk), late surgery in patients with disturbances of consciousness and over 50 years of age (major risk); preferably early surgery in younger patients even with disturbances of consciousness (intermediate risk); preferably late surgery in older patients, even being alert (intermediate risk).
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0942-0940
    Keywords: Cerebral vasospasm ; subarachnoid haemorrhage ; cisternal irrigation ; rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors have investigated the effect of very early irrigation of the cerebrospinal fluid (CSF) space in the haemorrhage rat model of vasospasm. Fifteen rats had basilar cistern irrigation with physiological saline for 3 hours after subarachnoid haemorrhage (SAH), and fifteen control rats had subarachnoid haemorrhage without irrigation of clot. The changes in basilar arteries diameters were determined by angiograms obtained from the rats. The post haemorrhage angiograms showed significant basilar artery spasm in both groups (P⩽0.0005, t-test). However in the last angiogram the basilar artery diameter was found to have the same value measured before subarachnoid haemorrhage in the irrigation group whereas no obvious change was observed in the control group. In the irrigation group the mean diameter of the basilar artery in the last angiogram was 0.412 mm. (0.30 mm to 0.50 mm). None of the animals, treated by cisternal irrigation, showed angiographic vasospasm while the latter group did (P⩽0.0005). Animals treated with physiological saline irrigation had a median clot grade of 0.40 (range grade 0 to 2); control rats had a median grade 2.86 (range grade 1 to 4, P〈0.001, Mann-Withney U test), on the brain stem, indicating significant reduction of clot by lavage. In conclusion, performance of experimental physiological saline irrigation at a very early time after subarachnoid haemorrhage prevents the arteriographic and morphological changes of both acute and late vasospasms.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 0942-0940
    Keywords: CT finding ; subarachnoid haemorrhage ; posterior circulation aneurysm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This report describes our retrospective evaluation of CT features of the acute phase in 34 cases of ruptured cerebral aneurysms of the posterior cranial fossa. The results are as follows. 1. Examination of cisternal haematoma distribution revealed that SAH had extended to the supra- and infratentorial cisterns in 28 cases (82%). There were only 6 cases (18%) in which SAH was confined to the posterior cranial fossa only but even when there was subarachnoid haematoma in both the supra- and infratentorial cisterns, thick haematomas were seen at the periphery of the brain stem. In cases of vertebral artery-posterior inferior cerebellar artery aneurysms (VA-PICA AN), haematomas in the ambient cistern were thicker on the aneurysm side. In addition, in cases of basilar arterybifurcation (BA-Bifurcation AN) and basilar artery-superior cerebelli artery aneurysms (BA-SCA AN), there were many thick, highdensity haematomas in the interpeduncular cistern. 2. The rate of intracerebral haemorrhage was extremely low (1 patient). 3. The rate of intraventricular haemorrhage was high, and these haemorrhages demonstrated a reflux pattern. 4. The rate of hydrocephalus was high (76.5%) in comparison with that noted in association with SAH due to the rupture of anterior circulation aneurysms.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 0942-0940
    Keywords: Intracranial pressure ; subarachnoid haemorrhage ; cerebral blood flow ; Cushing response
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The relationships of intracranial pressure (ICP), systemic blood pressure (SBP) and cerebral blood flow (CBF) during experimental subarachnoid haemorrhage were investigated in cats. Continuous monitoring of regional cerebral blood flow (rCBF) was done by a thermal diffusion method using a Peltier stack. During haemorrhage ICP rose within 5.4±0.97 minutes from 10.5±4.9 to 176.1±27.8 mmHg. This strong increase of ICP resulted in a temporary arrest of cerebral circulation. The Cushing response during the haemorrhage could not improve the cerebral circulation, but in contrast caused a further increase of ICP. After the haemorrhage the cerebral blood flow normalised within minutes. It is concluded, that the Cushing response during a subarachnoid haemorrhage should be regarded as a deleterious rather than a beneficial mechanism.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 0942-0940
    Keywords: Unruptured aneurysm ; operation ; indication ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors report a series of 37 cases of unruptured aneurysms, admitted and operated upon over a 5 year period (1985–1990), which represents an incidence of 18% of the total number of aneurysm patients operated upon during this period. These unruptured aneurysms were discovered in 4 types of circumstances: 1) Associated with a ruptured aneurysm but treated in a second procedure (9 cases); 2) After a transient ischaemic attack (6 cases); 3) After a cerebral haemorrhage of a different origin (3 cases), 4) After the onset of various neurological symptoms other than SAH (19 cases). Giant aneurysms (over 2.5 cm in diameter) are excluded from this series. Overall these 37 patients harboured 52 aneurysms, and 1 patient was operated upon on both sides. 27 aneurysms (52%) were located on the right side, 15 (29%) on the left side, and 10 (19%) on the midline. In the immediate post operative period, 1 patient died (2.6%) and 8 patients (21%) presented various complications. The outcome at 6 months was: death 2.6%, moderately disabled 8%, good recovery 89%. The arguments in favour of, or against, the surgical treatment of unruptured aneurysms are discussed in view of the literature. In favour of prophylactic surgery are: 1) The rather poor overall outcome following aneurysm rupture (including deaths before admission); 2) The rather good outcome of surgery in published series of unruptured aneurysms. The data of the natural history of the unruptured aneurysm are more questionable: in this view, surgery seems to be recommended in young patients with an easily accessible aneurysm and being in a good clinical condition. Several contra indications should be strictly accepted: severe associated diseases, age (over 65 and sometimes over 60), patient's refusal or reluctance. In cases of unruptured aneurysms to be operated upon in a second procedure after a ruptured aneurysm, the authors usually wait for 2 months or more before the second operation.
    Type of Medium: Electronic Resource
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