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Surgical Treatment of Anterior Circulation Aneurysms

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Neurosurgical Management of Aneurysmal Subarachnoid Haemorrhage

Part of the book series: Acta Neurochirurgica Supplements ((NEUROCHIRURGICA,volume 72))

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Summary

The purpose of this paper is to present the results, assessed by an independent observer, of surgical treatment of 428 consecutive patients harbouring aneurysms of the anterior circulation, together with a review of relevant anatomy and operative strategy.

At follow-up (mean 5.6 years) 89.3% lived at home and were independent, 5.1% lived at home but needed some kind of assistance, 2.0% lived in institution, whereas information was unavailable in 3.6% of living patients. Two hundred and fifty-three patients (64.5%) had unchanged employment status, 0.3% worked in sheltered environment, whereas 30.9% went out of work due to their subarachnoid hemorrhage (SAH). Information about employment status was unavailable in 4.3%. For aneurysms of the internal carotid, anterior communicating and middle cerebral artery, respectively, mortality was 3.2, 3.9 and 5.6%, whereas 92.0, 88.1 and 89.0% of surviving patients lived at home and were independent and 67.0, 63.6 and 63.0% had unchanged employment status.

Three-months mortality of all causes was 4.2%. In the postoperative period 53 (12.4%) patients developed clinical signs of vasospasms, 6 (1.4%) had cardiac infarction, 4 (0.9%) lung oedema, 4 (0.9%) deep vein thrombosis, and 7 patients (1.6%) infection. During the follow-up period shunt-dependent hydrocephalus developed in 4.2% and 0.2% had a subsequent SAH from the same aneurysm. Forty-three patients were on anticonvulsive therapy.

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  1. Department of Neurosurgery, Karolinska Hospital, Stockholm, Sweden

    Professor Iver A. Langmoen M.D., Ph.D. & K. Ekseth

  2. Department of Neurosurgery, National Hospital, Oslo, Norway

    E. Hauglie-Hanssen & H. Nornes

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  1. Department of Neurosurgery, Karolinska Hospital, Stockholm, Sweden

    Iver A. Langmoen M.D., Ph.D.

  2. Department of Neurosurgery, Rikshospitalet, The National Hospital, Oslo, Norway

    Tryggve Lundar

  3. Department of Neurological Surgery, Harborview Medical Center, Seattle, USA

    Rune Aaslid Ph.D.

  4. Department of Neurosurgery, Klinikum Großhadern, Munich, Germany

    Hans-J. Reulen M.D.

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Langmoen, I.A., Ekseth, K., Hauglie-Hanssen, E., Nornes, H. (1999). Surgical Treatment of Anterior Circulation Aneurysms. In: Langmoen, I.A., Lundar, T., Aaslid, R., Reulen, HJ. (eds) Neurosurgical Management of Aneurysmal Subarachnoid Haemorrhage. Acta Neurochirurgica Supplements, vol 72. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6377-1_10

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