Summary
240 patients with giant aneurysms admitted to 10 Italian centres were evaluated in regard to results of treatment and postoperative complications. As a whole, a complete recovery was observed in 39% of cases, various degrees of disability in 38% of cases, and death in 23% of cases, considering also patients admitted in Glasgow Coma Scale (GCS) 3–6. By excluding patients in GCS 3–6, active treatment was linked with a recovery rate of 47% and a mortality rate of 15%; the worst outcome was observed for carotid bifurcation aneurysms, the best for intracavernous aneurysms. In patients with giant carotid/ ophthalmic or supraclinoid aneurysms, the outcome was similar after early surgery and after indirect methods of treatment. Factors playing a negative influence on outcome were mainly early exclusion after haemorrhage, operative brain swelling and cisternal tamponade; induced hypotension was associated with a significant decrease in mortality.
Postoperative complications were observed in 48% of cases, and were mainly caused by ischaemic disturbances not associated with vasospasm (17% of cases), followed by surgical trauma and cerebral oedema; in 32 patients the postoperative neurological deterioration was fully reversible. In patients submitted to carotid occlusion as sociation with a by-pass did not decrease the rate of ischaemic complications.
In patients submitted to active treatments (open surgery or indirect methods of exclusion) the causes of morbidity were mainly: — deficits due to mass lesion, surgical complications, and ischaemic disturbances without vasospasm;the causes of mortality were mainly surgical trauma or medical complications.
Cooperative Group: R. Da Pian, A. Pasqualin, R. Scienza/A. Benedetti, D. Curri, L. Volpin/P. Mennonna, F. Ammannati, D. Serino/E. Morace, F. Cattani, R. Mastrostefano/V. A. D’Angelo, M. Ferrara, E. Fiumara/F. Filizzolo, M. Collice, G. D’Aliberti/G. Scialfa, G. Scotti, E. Boccardi/A. Andreoli, P. Limoni, C. Testa/M. Bortoluzzi, G. Marini/R. Galzio, D. Lucantoni/E. De Divitiis, R. Spaziante, F. D’Andrea/C. Ceccotto, P. P. Janes, A. Cramaro.
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Pasqualin, A., Battaglia, R., Scienza, R., Da Pian, R. (1988). Italian Cooperative Study on Giant Intracranial Aneurysms: 4. Results of Treatment. In: Isamat, F., Jefferson, A., Loew, F., Symon, L. (eds) Proceedings of the 8th European Congress of Neurosurgery Barcelona, September 6–11, 1987. Acta Neurochirurgica Supplementum 42, vol 42. Springer, Vienna. https://doi.org/10.1007/978-3-7091-8975-7_13
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DOI: https://doi.org/10.1007/978-3-7091-8975-7_13
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