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  • Jakobsson, Karl-Erik  (4)
  • Medicine  (4)
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  • Medicine  (4)
RVK
  • 1
    Online Resource
    Online Resource
    Overall management outcome of ruptured posterior fossa aneurysms
    Journal of Neurosurgery Publishing Group (JNSPG) ; 1996
    In:  Journal of Neurosurgery Vol. 85, No. 1 ( 1996-07), p. 33-38
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 85, No. 1 ( 1996-07), p. 33-38
    Abstract: ✓ A study of the overall management of ruptured posterior fossa aneurysms was conducted over a 1-year period (1993) in five neurosurgical centers in Sweden, serving a population of 6.93 million people. Forty-nine cases were identified and treated. One-third of the patients were in the seventh or eighth decade of life. Good overall management outcomes at 6 months were achieved in 30 cases (61%). The overall mortality rate was 27%. Patients with Hunt and Hess Grades I and II had a good overall recovery rate of 87%. On admission, 69% of the patients were assigned Hunt and Hess Grades III to V. The impact on patient outcomes of the intraoperative difficulties encountered, especially in the basilar tip area, is stressed. The authors found that delayed operation is not warranted in most cases. Frequent devastating rebleeding was observed among patients not offered early aneurysm clipping and the operative results were not at significant variance between the early and late surgical groups. Only 50% of the patients scheduled for delayed surgery ultimately made a good recovery, whereas 72% of patients scheduled for early operation did so. The data demonstrate that overall management results with posterior fossa aneurysms, comparable to achievements with supratentorial lesions, are within the reach of modern strategies, even in centers not specializing in these problems.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.1996.85.1.0033
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 1996
    detail.hit.zdb_id: 2026156-1
    Location Call Number Limitation Availability
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Intraoperative complications in aneurysm surgery: a prospective national study
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2002
    In:  Journal of Neurosurgery Vol. 96, No. 3 ( 2002-03), p. 515-522
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 96, No. 3 ( 2002-03), p. 515-522
    Abstract: Object. With increasing use of endovascular procedures, the number of aneurysms treated surgically will decline. In this study the authors review complications related to the surgical treatment of aneurysms and address the issue of maintaining quality standards on a national level. Methods. A prospective, nonselected amalgamation of every aneurysm case treated in five of six neurosurgical centers in Sweden during 1 calendar year was undertaken (422 patients; 7.4 persons/100,000 population/year). The treatment protocols at these institutions were very similar. Outcome was assessed using clinical end points. In this series, 84.1% of the patients underwent surgery, and intraoperative complications occurred in 30% of these procedures. Poor outcome from technical complications was seen in 7.9% of the surgically treated patients. Intraoperative aneurysm rupture accounted for 60% and branch sacrifice for 12% of all technical difficulties. Although these complications were significantly related to aneurysm base geometry and the competence of the surgeon, problems still occurred apparently at random and also in the best of hands (17%). The temporary mean occlusion time in the patients who suffered intraoperative aneurysm rupture was twice as long as the temporary arrest of blood flow performed to aid dissection. Conclusions. The results obtained in this series closely reflect the overall management results of this disease and support the conclusion that surgical complications causing a poor outcome can be estimated on a large population-based scale. Intraoperative aneurysm rupture was the most common and most devastating technical complication that occurred. Support was found for a more liberal use of temporary clips early during dissection, regardless of the experience of the surgeon. Temporary regional interruption of arterial blood flow should be a routine method for aneurysm surgery on an everyday basis. A random occurrence of difficult intraoperative problems was clearly shown, and this factor of unpredictability, which is present in any preoperative assessment of risk, strengthens the case for recommending neuroprotection as a routine adjunct to virtually every aneurysm operation, regardless of the surgeon's experience.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.2002.96.3.0515
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2002
    detail.hit.zdb_id: 2026156-1
    Location Call Number Limitation Availability
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    Online Resource
  • 3
    Online Resource
    Online Resource
    Overall outcome in aneurysmal subarachnoid hemorrhage : A prospective study from neurosurgical units in Sweden during a 1-year period
    Journal of Neurosurgery Publishing Group (JNSPG) ; 1992
    In:  Journal of Neurosurgery Vol. 76, No. 5 ( 1992-05), p. 729-734
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 76, No. 5 ( 1992-05), p. 729-734
    Abstract: ✓ The present prospective study, with participation of five of the six neurosurgical centers in Sweden, was conducted to evaluate the overall management results in patients with aneurysmal subarachnoid hemorrhage (SAH). The participating centers covered 6.93 million (81%) of Sweden's 8.59 million inhabitants. All patients with verified aneurysmal SAH admitted between June 1, 1989, and May 31, 1990, were included in this prospective study. A uniform management protocol was adopted involving ultra-early referral, earliest possible surgery, and aggressive anti-ischemic treatment. A total of 325 patients were admitted during the study period, 69% within 24 hours after hemorrhage. On admission, the patients were graded according to the scale of Hunt and Hess: 43 patients (13%) were classified in Grade I, 119 (37%) in Grade II, 53 (16%) in Grade III, 76 (23%) in Grade IV, and 34 (II%) in Grade V. Nimodipine was administered to 269 of the 325 patients: intravenously in 218, orally in 15, and intravenously followed by orally in 36. At follow-up examination 3 to 6 months after SAH, 183 patients (56%) were classified as having made a good neurological recovery, 73 patients (23%) suffered some morbidity, and 69 (21%) were dead. Surgery was performed in 276 (85%) of the patients; emergency surgery with evacuation of an associated intracerebral hematoma was carried out in 30 patients. Early surgery (within 72 hours after SAH) was performed in 170 individuals, intermediate surgery (between Days 4 and 6 post-SAH) in 29 patients, and late surgery (Day 7 or later after SAH) in 47 individuals. Of 145 patients with supratentorial aneurysms who were preoperatively in Hunt and Hess Grades I to III and who were treated within 72 hours, 81 made a good recovery; in 5.5% of patients, the unfavorable outcome was ascribed to delayed ischemia. It is concluded that, among patients with all clinical grades and aneurysmal locations, almost six of 10 SAH victims referred to a neurosurgical unit can be saved and can recover to a normal life.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.1992.76.5.0729
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 1992
    detail.hit.zdb_id: 2026156-1
    Location Call Number Limitation Availability
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    Online Resource
  • 4
    Online Resource
    Online Resource
    Warning leak and management outcome in aneurysmal subarachnoid hemorrhage
    Journal of Neurosurgery Publishing Group (JNSPG) ; 1996
    In:  Journal of Neurosurgery Vol. 85, No. 6 ( 1996-12), p. 995-999
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 85, No. 6 ( 1996-12), p. 995-999
    Abstract: ✓ The impact of warning leaks on management results in patients with aneurysmal subarachnoid hemorrhage (SAH) was evaluated in this prospective study. In a consecutive series of 422 patients with aneurysmal SAH, 84 patients (19.9%) had an episode suggesting a warning leak; 34 (40.5%) of these patients were seen by a physician without the condition being recognized. The warning leak occurred less than 2 weeks before a major SAH in 75% of the patients. A good outcome was experienced by 53.6% of patients who had a warning leak versus 63.3% of those who had no warning leak. In a subgroup of patients who had an interval of 3 days or less from warning leak to SAH, only 36.4% had a good outcome. The proportion of patients in good neurological condition (Hunt and Hess Grades I and II) who had a good outcome was 88.1% in the group with no warning leak versus 53.6% in the group whose SAH was preceded by a warning leak. A difference of 35% between these two groups reflects the impact of an undiagnosed warning leak on patient outcome, based on the assumption that patients with a warning leak had clinical conditions no worse than Hunt and Hess Grade II at the time of the episode. In the subgroup of patients with the short interval between warning leak and SAH, the difference was almost 52%. The difference in outcome also reflects the potential improvement in outcome that can be achieved by a correct diagnosis of the warning leak. If the correct diagnosis is made in patients seeking medical attention due to a warning leak, favorable outcomes in the overall management of aneurysmal SAH are estimated to increase by 2.8%. An active diagnostic attitude toward patients experiencing a sudden and severe headache is warranted as it offers a means of improving overall outcome in patients with SAH.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.1996.85.6.0995
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 1996
    detail.hit.zdb_id: 2026156-1
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
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