Management cerebraler Aneurysmen - Erfassung des Therapieverlaufs in einer flexiblen Datenbank
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Philipps-Universität Marburg
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Abstract
INTRODUCTION
The neurosurgical clinic and the
neuroradiologic department of Philipps-University Marburg are
specialised in diagnosis and therapy of neurovascular diseases.
The neurosurgeons are particular skilled in skull-base-surgery.
From May 1997 to December 1999 in total 223 patients with
either cerebral Aneurysm (160 patients) or subarachnoid
hemorrhage (SAB) of other cause (63 Patienten) were
hospitalised. These patients formed the completely unselected
population of the study. The study aimed to characterise this
population and report their short-term outcome.
METODS AND
PATIENTS
Data was acquired with a self-built electronic
database. The database consits of linked tables and works with
predefined values, automatic calculating and counting,
selecting maximum settings. To take full use of the data
summarising and cross-tables were implemented to automaticially
group and count data. The patients with aneurysm have been
grouped in ?local patients? and
?Cerebrovascular-Center Patienten? (CV-Patients)
regarding to their address.
The average age of patients with
aneurysms was 49,1 (+/-14,9) years; complies to literature [61;
82; 93]. 2,5% of all and 0% of local patients were 18 years or
younger; literature 0,5% [83]. 70% of patients were female;
literature about 60% [43; 83].
CV-patients had significantly
more often aneurysms located either near the skull-base
(proximal A. carotis interna=ACI 24%) or in the vertebrobasilar
circulation (35%) than local patients (8% / 18%); literature:
posterior location 6-10% in operativ [61; 82; 181], 28-57% in
interventional studies [21; 109; 175]. Admission of patients
with posterior and skull-base aneurysms from more distant parts
of the country is most likely caused by the combination of
sophisticated neurovascular and neurosurgical experience.
RESULTS COMPARED WITH PUBLICATIONS
Patients with ruptured
aneurysm were on discharge in 26% mild, in 22% severely
handicaped or vegetative; literature: 9-17% mild [51; 82; 90;
131], 7-21% severely handicaped or vegetative [43; 51; 90;
131]. The mortality of our patients was 7,4%; Literatur mainly
>20% [24; 43; 55; 82; 104; 134; 152; 158], within selected
populations 16-18% [51; 90; 102], 8,4% [126], even 3,5% [131].
Patients with unruptured aneurysm were on discharge in 14,3%
mild, in 11,4% severely handicaped, no patient died; literatur:
Mortality 0-2,3% [53; 74; 86; 117; 141], morbidity 4-6% [51;
90; 102], but: Need for rehabilitation in 16,2% [74].
Our
morbidity was higher as we didn?t apply any exclusion
criteria and messured outcome early, morbidity is decreasing in
the first months [43; 131; 139; 163].
Morbidity und mortality
of operative und neurovascular treated patients were close to
those of the total population. Single exeption: Operation 32%,
intervention 14%, total population 26% mild handicapes with
ruptured aneurysms.
Our patients had low mortality
irrespective of the location of their aneurysms. With aneurysms
of the posterior circulation and of the carotid artery
(including many proximal ACI aneurysms) our patients suffered
less complications than those in published studies. Not only
interventionel, also operative outcome was with posterior
located aneurysms as good as with anterior aneurysms; contrary
to literature [60; 82; 134; 139; 171]. The most likely reason
for the good results with aneurysms to which a bad prognosis is
often attributed is the interdisciplinary approach and the
specialisation on skull-base operations in neurosurgery.
CONCLUSION
Every therapeutic approach shows good results when
the correct indication is applied: Operativ therapy is gold
standart for cerebral aneurysm and always indicated if none of
the alternative therapeutic options offers lower longterm
morbidity. Neuroradiologic therapy is less invasive but long
term data on efficiancy is still laking. Intervention should
therefore be considered if the aneurysm is e.g. posterior or
proximal located or if the patient is to poor to stand an
operation. Conservative therapy ist indicated, if the risk of
active therapy is higher than the long term risk of SAH; e.g.
extradural ACI aneurysms or short life expectancy.
We
don?t think endovascular and operativ therapy should be
compared directly, as different indications apply. Some
articles support our view [163]. A comparison of different
regimes, using different indications is required, a simple
comparison of neurovascular and neurosurgical results not
helpful. Outcome of all aneurysm patients, not only the
surgical or interventional treated ones matters [125].
Only a
prospective, long term follow up multicenterstudy with
randomising patients not to different therapies but to
different management regimes, each implementing opera-tive,
interventional and conservative therapy, will show how to treat
most succesfull.
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Supervisor:
Dates
Created: 2003Issued: 2004-01-14Updated: 2011-08-10
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Morbidity , MorbidityCerebral AneurysmSubarachnoid hemorrhageNeurosurgery
DFG-subjects
SchädelbasisIntrakranielles AneurysmaNeurochirurgieKind / NeurochirurgieNeuroradiologieSterblichkeitMorbidität
DDC-Numbers
610
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Schramm, Jochen (Udo) (128676639): Management cerebraler Aneurysmen - Erfassung des Therapieverlaufs in einer flexiblen Datenbank. : Philipps-Universität Marburg 2004-01-14. DOI: https://doi.org/10.17192/z2003.0677.
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This item has been published with the following license: In Copyright