The International Cooperative Study on the Timing of Aneurysm Surgery

Journal of Neurosurgery - Tập 73 Số 1 - Trang 37-47 - 1990
Neal F. Kassell1, James C. Torner, John C. Flíckinger, E. Clarke Haley, H P Adams
1Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville

Tóm tắt

✓ A prospective, observational clinical trial was conducted by the International Cooperative Study on the Timing of Aneurysm Surgery to determine the best time in relation to the hemorrhage for surgical treatment of ruptured intracranial aneurysms. Sixty-eight centers contributed 3521 patients in a 2½-year period beginning in December, 1980. Analysis by a prespecified “planned” surgery interval demonstrated that there was no difference in early (0 to 3 days after the bleed) or late surgery (11 to 14 days). Outcome was worse if surgery was performed in the 7 to 10-day post-bleed interval. Surgical results were better for patients operated on after 10 days. Patients alert on admission fared best; however, alert patients had a mortality rate of 10% to 12% when undergoing surgery prior to Day 11 compared with 3% to 5% when surgery was performed after Day 10. Patients drowsy on admission had a 21% to 25% mortality rate when operated on up to Day 11 and 7% to 10% with surgery thereafter. Overall, early surgery was neither more hazardous nor beneficial than delayed surgery. The postoperative risk following early surgery is equivalent to the risk of rebleeding and vasospasm in patients waiting for delayed surgery.

Từ khóa


Tài liệu tham khảo

Adams, 1976, Intracranial aneurysms: analysis of results of microneurosurgery., 2, 607, 10.1136/bmj.2.6036.607

Adams, 1981, Early management of aneurysmal subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study., 54, 141, 10.3171/jns.1981.54.2.0141

Alvord, 1972, Subarachnoid hemorrhage due to ruptured aneurysms. A simple method of estimating prognosis., 27, 273, 10.1001/archneur.1972.00490160001001

Bohm, 1970, Results of surgical treatment of 200 consecutive cerebral arterial aneurysms., 46, 43, 10.1111/j.1600-0404.1970.tb05603.x

Bolander, 1984, Retrospective analysis of 162 consecutive cases of ruptured intracranial aneurysms. Total mortality and early surgery., 70, 31, 10.1007/BF01406040

Cox, 1972, Regression models and life-tables., 34, 187

Dorsch, 1984, Surgery for cerebral aneurysms, an eight year experience., 141, 18, 10.5694/j.1326-5377.1984.tb132661.x

Drake, 1976, Cerebral aneurysm surgery: an update, 289

Drake, 1981, Management of cerebral aneurysm., 12, 273, 10.1161/01.STR.12.3.273

Fisher, 1980, Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning., 6, 1, 10.1227/00006123-198001000-00001

Fisher, 1977, Cerebral vasospasm with ruptured saccular aneurysm — the clinical manifestations., 1, 245, 10.1227/00006123-197711000-00004

Flamm, 1977, Parasurgical treatment of aneurysms., 24, 240, 10.1093/neurosurgery/24.CN_suppl_1.240

Fleischer, 1980, Cerebral vasospasm following aneurysm rupture. A protocol for therapy and prophylaxis., 52, 149, 10.3171/jns.1980.52.2.0149

Graf, 1974, Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Report of a randomized treatment study. III. Intracranial surgery., 5, 559

Hamby, 1970, Remarks concerning intracranial aneurysm surgery., 17, 1, 10.1093/neurosurgery/17.CN_suppl_1.1

Hashi, 1982, Surgery in the prevasospastic interval., 63, 141, 10.1007/BF01728866

Hollin, 1973, Effectiveness of microsurgery for intracranial aneurysms. Postoperative angiographic study of 50 cases., 39, 690, 10.3171/jns.1973.39.6.0690

Hunt, 1968, Surgical risk as related to time of intervention in the repair of intracranial aneurysms., 28, 14, 10.3171/jns.1968.28.1.0014

Hunt, 1974, Timing and perioperative care in intracranial aneurysm surgery., 21, 79, 10.1093/neurosurgery/21.CN_suppl_1.79

Hunt, 1977, The results of early operation for aneurysm., 24, 208, 10.1093/neurosurgery/24.CN_suppl_1.208

Jane, 1977, The natural history of intracranial aneurysms. Rebleeding rates during the acute and long-term period and implications for surgical management., 24, 176, 10.1093/neurosurgery/24.CN_suppl_1.176

Jennett, 1975, Assessment of outcome after severe brain damage. A practical scale., 1, 480

Kassell, 1981, Overall management of ruptured aneurysm: comparison of early and late operation., 9, 120, 10.1227/00006123-198108000-00002

Kassell, 1982, Timing of aneurysm surgery., 10, 514, 10.1227/00006123-198204000-00019

Kassell, 1990, The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results., 73, 000

Koos, 1982, Timing of surgery for ruptured aneurysms — experience from 800 consecutive cases., 63, 125, 10.1007/BF01728864

Ljunggren, 1981, Results of early operations for ruptured aneurysms., 54, 473, 10.3171/jns.1981.54.4.0473

Ljunggren, 1983, Causes of unfavorable outcome after early aneurysm operation., 13, 629, 10.1227/00006123-198312000-00001

Lougheed, 1969, Selection, timing, and technique of aneurysm surgery of the anterior circle of Willis., 16, 95, 10.1093/neurosurgery/16.CN_suppl_1.95

Mullan, 1978, Management of 136 consecutive supratentorial berry aneurysms., 49, 794, 10.3171/jns.1978.49.6.0794

Nishimoto, 1985, Nationwide Cooperative Study of intracranial aneurysm surgery in Japan., 16, 48, 10.1161/01.STR.16.1.48

Öhman, 1989, Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study., 70, 55, 10.3171/jns.1989.70.1.0055

Pool, 1962, Timing and techniques in the intracranial surgery of ruptured aneurysms of the anterior communicating artery., 19, 378, 10.3171/jns.1962.19.5.0378

Post, 1977, Ruptured intracranial aneurysms. Case morbidity and mortality., 46, 290, 10.3171/jns.1977.46.3.0290

Richardson, 1966, The prediction of morbidity and mortality in anterior communicating aneurysms treated by proximal anterior cerebral ligation., 25, 280, 10.3171/jns.1966.25.3.0280

Richardson, 1966, Prognostic factors in the untreated course of posterior communicating aneurysms., 14, 172, 10.1001/archneur.1966.00470080056008

Saito, 1973, Surgical treatment of intracranial aneurysms in the acute stage, with special reference to pre- and postoperative vasospasm, 160

Saito, 1977, Significance of vasospasm in the treatment of ruptured intracranial aneurysms., 47, 412, 10.3171/jns.1977.47.3.0412

Samson, 1979, Risk of intracranial aneurysm surgery in the good grade patient: early versus late operation., 5, 422, 10.1227/00006123-197910000-00002

Sano, 1978, Timing and indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasm., 41, 49, 10.1007/BF01809136

Shephard, 1983, Ruptured cerebral aneurysms: early and late prognosis with surgical treatment. A personal series, 1958–1980., 59, 6, 10.3171/jns.1983.59.1.0006

Sundt, 1977, Cerebral vasospasm following subarachnoid hemorrhage: evolution, management, and relationship to timing of surgery., 24, 228, 10.1093/neurosurgery/24.CN_suppl_1.228

Sundt, 1982, Results and complications of surgical management of 809 intracranial aneurysms in 722 cases. Related and unrelated to grade of patient, type of aneurysm, and timing of surgery., 56, 753, 10.3171/jns.1982.56.6.0753

Sundt, 1978, Subarachnoid hemorrhage from intracranial aneurysms. Surgical management and natural history of disease., 299, 116, 10.1056/NEJM197807202990303

Suzuki, 1979, Results of early operations on cerebral aneurysms., 11, 407

Takaku, 1979, Postoperative complications in 1,000 cases of intracranial aneurysms., 12, 137

Taneda, 1983, Biphasic occurrence of delayed ischemia after early aneurysm surgery. Case report., 58, 440, 10.3171/jns.1983.58.3.0440

Tucker, 1987, The relationship between timing of surgery and operative complications in aneurysmal subarachnoid hemorrhage., 14, 84, 10.1017/S0317167100026895

Weir, 1982, Management and postoperative mortality related to time of clipping for supratentorial aneurysms. A personal series., 63, 135, 10.1007/BF01728865

Weir, 1981, Management mortality and the timing of surgery for supratentorial aneurysms., 54, 146, 10.3171/jns.1981.54.2.0146

Whisnant, 1982, Aneurysmal subarachnoid hemorrhage timing of surgery and mortality., 57, 471

Wilkins, 1977, The role of intracranial arterial spasm in the timing of operations for aneurysm., 24, 185, 10.1093/neurosurgery/24.CN_suppl_1.185

Yoshimoto, 1979, An analysis of follow-up results of 1000 intracranial saccular aneurysms with definitive surgical treatment., 50, 152, 10.3171/jns.1979.50.2.0152