Emergent aneurysm surgery without cerebral angiography for the comatose patient

H. H. Batjer, D. S. Samson

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Neurologically based clinical grading scales offer excellent prognostic information for the patient suffering diffuse subarachnoid hemorrhage (SAH). These grading scales are less applicable to patients with life-threatening intraparenchymal hematomas after aneurysmal rupture. During the last 3 years, four patients in a comatose state with brain stem compression syndromes documented by computed tomographic scans have undergone emergent operation in our neurosurgical service. Each patient was so critically ill that we believed it unwise to delay craniotomy for diagnostic angiography. The average delay from the onset of coma to skin incision was 3.02 hours (range, 1.67-6.5 hours), and the average delay from arrival in our unit until skin incision was 1.8 hours (range, 0.75-2.5 hours). The condition of two arousable patients deteriorated while they were in the emergency room, presumably from new bleeding. Each patient underwent craniotomy for hematoma evacuation, definitive aneurysm clipping, and lobectomy for decompression. Temporary clipping was employed in one patient, and intraoperative rupture occurred in two others. Three patients survived but retain significant disability. Emergent craniotomy with empiric exploration of appropriate subarachnoid cisterns after hematoma decompression may be life-saving in some cases. The delay imposed for diagnostic angiography may be avoided in attempts to save vital minutes of severe brain stem compression.

Original languageEnglish (US)
Pages (from-to)283-287
Number of pages5
JournalNeurosurgery
Volume28
Issue number2
StatePublished - 1991

Fingerprint

Cerebral Angiography
Coma
Aneurysm
Craniotomy
Hematoma
Decompression
Brain Stem
Rupture
Angiography
Skin
Subarachnoid Hemorrhage
Critical Illness
Hospital Emergency Service
Hemorrhage

Keywords

  • Early aneurysm surgery
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Emergent aneurysm surgery without cerebral angiography for the comatose patient. / Batjer, H. H.; Samson, D. S.

In: Neurosurgery, Vol. 28, No. 2, 1991, p. 283-287.

Research output: Contribution to journalArticle

@article{c960d62850eb45d2a92e5eff63b0399e,
title = "Emergent aneurysm surgery without cerebral angiography for the comatose patient",
abstract = "Neurologically based clinical grading scales offer excellent prognostic information for the patient suffering diffuse subarachnoid hemorrhage (SAH). These grading scales are less applicable to patients with life-threatening intraparenchymal hematomas after aneurysmal rupture. During the last 3 years, four patients in a comatose state with brain stem compression syndromes documented by computed tomographic scans have undergone emergent operation in our neurosurgical service. Each patient was so critically ill that we believed it unwise to delay craniotomy for diagnostic angiography. The average delay from the onset of coma to skin incision was 3.02 hours (range, 1.67-6.5 hours), and the average delay from arrival in our unit until skin incision was 1.8 hours (range, 0.75-2.5 hours). The condition of two arousable patients deteriorated while they were in the emergency room, presumably from new bleeding. Each patient underwent craniotomy for hematoma evacuation, definitive aneurysm clipping, and lobectomy for decompression. Temporary clipping was employed in one patient, and intraoperative rupture occurred in two others. Three patients survived but retain significant disability. Emergent craniotomy with empiric exploration of appropriate subarachnoid cisterns after hematoma decompression may be life-saving in some cases. The delay imposed for diagnostic angiography may be avoided in attempts to save vital minutes of severe brain stem compression.",
keywords = "Early aneurysm surgery, Subarachnoid hemorrhage",
author = "Batjer, {H. H.} and Samson, {D. S.}",
year = "1991",
language = "English (US)",
volume = "28",
pages = "283--287",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Emergent aneurysm surgery without cerebral angiography for the comatose patient

AU - Batjer, H. H.

AU - Samson, D. S.

PY - 1991

Y1 - 1991

N2 - Neurologically based clinical grading scales offer excellent prognostic information for the patient suffering diffuse subarachnoid hemorrhage (SAH). These grading scales are less applicable to patients with life-threatening intraparenchymal hematomas after aneurysmal rupture. During the last 3 years, four patients in a comatose state with brain stem compression syndromes documented by computed tomographic scans have undergone emergent operation in our neurosurgical service. Each patient was so critically ill that we believed it unwise to delay craniotomy for diagnostic angiography. The average delay from the onset of coma to skin incision was 3.02 hours (range, 1.67-6.5 hours), and the average delay from arrival in our unit until skin incision was 1.8 hours (range, 0.75-2.5 hours). The condition of two arousable patients deteriorated while they were in the emergency room, presumably from new bleeding. Each patient underwent craniotomy for hematoma evacuation, definitive aneurysm clipping, and lobectomy for decompression. Temporary clipping was employed in one patient, and intraoperative rupture occurred in two others. Three patients survived but retain significant disability. Emergent craniotomy with empiric exploration of appropriate subarachnoid cisterns after hematoma decompression may be life-saving in some cases. The delay imposed for diagnostic angiography may be avoided in attempts to save vital minutes of severe brain stem compression.

AB - Neurologically based clinical grading scales offer excellent prognostic information for the patient suffering diffuse subarachnoid hemorrhage (SAH). These grading scales are less applicable to patients with life-threatening intraparenchymal hematomas after aneurysmal rupture. During the last 3 years, four patients in a comatose state with brain stem compression syndromes documented by computed tomographic scans have undergone emergent operation in our neurosurgical service. Each patient was so critically ill that we believed it unwise to delay craniotomy for diagnostic angiography. The average delay from the onset of coma to skin incision was 3.02 hours (range, 1.67-6.5 hours), and the average delay from arrival in our unit until skin incision was 1.8 hours (range, 0.75-2.5 hours). The condition of two arousable patients deteriorated while they were in the emergency room, presumably from new bleeding. Each patient underwent craniotomy for hematoma evacuation, definitive aneurysm clipping, and lobectomy for decompression. Temporary clipping was employed in one patient, and intraoperative rupture occurred in two others. Three patients survived but retain significant disability. Emergent craniotomy with empiric exploration of appropriate subarachnoid cisterns after hematoma decompression may be life-saving in some cases. The delay imposed for diagnostic angiography may be avoided in attempts to save vital minutes of severe brain stem compression.

KW - Early aneurysm surgery

KW - Subarachnoid hemorrhage

UR - http://www.scopus.com/inward/record.url?scp=0026034642&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026034642&partnerID=8YFLogxK

M3 - Article

VL - 28

SP - 283

EP - 287

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 2

ER -