PMID: 15352627Sep 9, 2004Paper

Differences in outcome in patients with poor grade subarachnoid hemorrhage (WFNS grade IV and V): according to the perioperative management against vasospasm

No shinkei geka. Neurological surgery
Yasunobu Goto, S Yamagata

Abstract

Cerebral vasospasm remains a leading cause of morbidity and increasing mortality rates following aneurysmal subarachnoid hemorrhage (SAH). The rate of vasospasm and the outcome (Glasgow Outcome Scale; GOS) especially in poor WFNS grade were retrospectively analyzed over a 6-year period. Patients were divided into three different groups. The first group (pre-group) consisted of 43 patients (grade IV: 31, grade V: 12), who were admitted between 1996 and 1998. When vasospasm occurred, they were mainly treated by papaverine (PPV) and percutaneous transluminal angioplasty (PTA). In the second group (mil-cis group), for the prevention of vasospasm, cisternal irrigation therapy with milrinone was applied in 24 patients (grade IV: 13, grade V: 11), who were admitted in the period between 1999 and 2001. The third group, (w/o mil-cis group), consisted of 30 patients (grade IV: 15, grade V: 15), in whom cisternal irrigation therapy was not able to be carried out. In grade IV, vasospasm was observed in 66% of the patients the first group, 50% in the w/o mil-cis group and significantly less in the mil-cis group (15%, p<0.024). In grade V, the rate of vasospasm was also lower in the mil-cis group but no statistical significance was revealed....Continue Reading

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