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Principles of Medical Manegment of Spontaneus Subarachnoidal Heamaragiae

Al. Gvelesiani, D. Gugutcidze, N. Bakradze, M. Gelashvili, R. Bechvaia
Georgian Neurogical Center,
medical instiute “Tbilisi”

Aneurysmal SAH remains a neurologic disease with high mortality and disability. We reviewed general principles of medical management and analyzed results of surgical treatment of 189 patients.

Methods. Early surgery (within 36-48 hours after the hemorrhage) was performed in patients who were either in a good condition on admission(H-H I ,II) or required acute surgical intervention because of an early rebleed, presence of large hematoma, or severe hydrocephalus (H-H III). 58 did not undergo surgery (H-H IV-V). All postoperative patients with vasospasm received hyperdynamic therapy. Mortality among postoperative patients was 15,81%. All this case was joined with rebleeding in timeof delayed surgery due to vasospasm and brain swelling.

Conclusion. Microsurgical clip ligation remains the best treatment for most aneurysms. Early surgery prevents rebleeding and decreases a probability of cerebral vasospasm.

Literature:

1. International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured intracranial aneurysms - Risk of rupture and risks of surgical intervention. N. Engl.J.Med.339: 1693, 2000.

2. Adams and Victor’s Principles of Neurology. Maurice Victor. Allan H.Ropper - 7th ed. 2001.

3. John P.Weaver. Subarachnoid Hemorrhage. Stroke. Fisher CM. 2000.

4. Kassell N.F., Torner JC, Haley EC Jr, et al: The International Cooperative Study on the Timing of Aneurysm Surgery: Part 1. Overall management results. J.Neurosurg 73;18, 1990; Part 2;

Surgical results. J Neurosurg 73:37, 1990.

5. Ojemann RG, Ogilvy Cs, Crowell RM, Heros Rc: Surgical Management of Neurovascular Diseases, 3rd ed.Baltimore, Williams &Wilkins, 1995.

6. Stefan Schwab, Makkus Bertram, and Werner Hacke. Critical care of Cerebrovascular Disease.Stroke. Fisher CM. 2000.

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