Biomedical subjects

R Deruty

Publications and source records attributed to R Deruty.

At least 37 records · Page 2Linked to original sources

PubMed1994

The use of Teflon as wrapping material in aneurysm surgery.

Even if clipping is the ideal and only complete treatment of the intracranial aneurysm, wrapping is a well-known alternative technique when aneurysm clipping is not feasible, or is not completely satisfactory. We present a technique of wrapping using fibres of Teflon material shaped in strings or in pledgets, arranged on or around the area to be treated and fixed by fibrin glue. This Teflon technique was used during the years 1990 to 1992, in 44 treated aneurysms (33% or all aneurysms treated during the same period), and in 3 situations: 1) to reinforce a residual or additional ectasia next to the clipped aneurysm, usually proximal to the clip (25 cases, i.e., 57%), 2) to treat an arterial ectasia, so called preaneurysmal ectasia, which proved not clippable at surgery (10 cases, 23%) and 3) to protect a nervous or vascular neighbouring structure which was compressed by the clip grip (9 cases, 20%). No complication was noted in relation to this technique. Up to now, no other know wrapping material has received worldwide approval for being completely innocuous and effective. The Teflon material has been widely used in neurosurgical microvascular decompression and in cardiovascular surgery. In these fields, its reliability, safety, and lack of harmful effects have been widely recognized and should also apply in aneurysm surgery. A very long follow-up will be necessary to assess the outcome for this new wrapping technique.

Bandages↗

PubMed1993

The combined management of cerebral arteriovenous malformations. Experience with 100 cases and review of the literature.

A series of 100 patients treated for a cerebral arteriovenous malformation (AVM) is presented. Patients were admitted between 1985 and April 1992. Two groups are considered: the first group including 52 patients treated before the availability of radiosurgery (1985-1988), and the second group including 48 patients treated after the availability of radiosurgery (1989-1992). AVM's were classified in five grades according to the Spetzler's Grading System. Three techniques of treatment were used: surgical resection, intravascular embolization (with cyanoacrylate), and radiosurgery (linear accelerator). These three techniques were used either alone or in association, giving four types of management: surgical resection alone, embolization and resection, embolization alone, and radiosurgery (alone, or after embolization, or after surgical resection). From 1989 on, the availability of radiosurgery was responsible for the decrease of the "embolization and resection" group, which until then was predominantly used as well for low-grade (I, II, III) as for high-grade AVM's (IV, V). Overall, for the low-grade AVM's, the treatment of choice was surgical resection (79% of cases), with pre-operative embolization in one-half of these cases; the other low-grade AVM's were irradiated, with various combinations. For the high-grade AVM's, the treatment of choice was intravascular embolization (95% of cases), either alone, or followed by resection (45%) or radiosurgery (9%). Results were evaluated in terms of deterioration following treatment, in five groups: no deterioration (59%), minor deterioration (20%), long-lasting deficit (10%), major deterioration (5%), and death (6%). Overall, results improved after 1989: favourable outcome (no deterioration and minor deterioration) increased from 67% to 90%. Results were not related to the patients' age. More favourable results were obtained for low-grade AVM's (93%) than for high-grade AVM's (60%). For the low-grade AVM's the evolution from 1989 on (favourable outcomes increasing from 89% to 96%) occurred with the lowering of the mortality rate. For the high-grade AVM's, the evolution from 1989 onwards (favourable outcome increasing from 46% to 78%) occurred with the decrease of the cases with deficits. The angiographic results were strongly related to the management: 95% of complete eradication after surgical resection and 5% only after embolization alone. Concerning the results in irradiated cases, the follow-up is not long enough. The review of the neurosurgical literature since 1972 demonstrates progressive modifications in the therapeutic attitude as regards AVM's. The surgical management which was predominantly used at the beginning gave way progressively to a combined management, with a combination of embolization, surgery, and lately radiosurgery.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1993

Routine use of the CO2 laser technique for resection of cerebral tumours.

The CO2 laser technique has been routinely used from 1988 through 1992 for the resection of 93 cerebral tumours (meningiomas 58%, gliomas 15%, neurinomas 9%, miscellaneous 18%). The CO2 laser technique was found the more effective 1) in tumours of hard consistency, 2) in large or giant tumours, 3) in tumours with scarce vascularization. Meningiomas were the indication of choice (54 cases that is 58% of all tumours treated with CO2 laser, and 64% of all meningiomas operated on during the same period). Among the meningiomas treated with the CO2 laser, 54% were located on the skull base. The CO2 laser beam provides good haemostasis of small vessels during the vaporization process. When attached to the operative microscope, the other advantages of the CO2 laser technique are: the absence of a handle-piece, the absence of manual manipulation of the tumour, the coaxiality of the laser beam with the visual beam. The disadvantages are: the rigidity of the coupled microscope-Laser arm, the smoke produced by the vaporization of hard tumours, the noise of the device.

Brain Neoplasms↗

PubMed1993

Medulloblastoma in adults: survival and prognostic factors.

The authors report a series of 30 adults with medulloblastoma treated after surgery between 1975 and 1990. Half the patients presented a classical medulloblastoma and the other half presented desmoplastic medulloblastoma. Brainstem infiltration was noted in 3 patients, cerebellar peduncle infiltration in 6 cases and 4 patients had cerebrospinal fluid (CSF) involvement. Tumor resection was achieved in all patients except 1, and in 5 surgery was incomplete. All patients but 2 received postoperative cerebral radiotherapy. Six patients did not receive chemotherapy before radiotherapy, 7 patients received CCNU-Vincristine concomitantly with and after irradiation, 1 patient was given a CHOP regimen, and the remaining 16 patients received the 8 drugs in a 1-day (8/1) regimen before irradiation. The median follow-up time was 104 months. The 5- and 10-year overall survival rates were 58.5% and 41%, respectively. Two toxic deaths occurred under the 8/1 regimen, and no better survival was observed for this group of patients in comparison with those receiving other regimens. Persistence of malignant cells in the CSF, brainstem involvement, cerebellar peduncle infiltration, non-radical surgery and a postoperative performance status (PS) of more than 2 were significantly correlated with an adverse outcome for overall survival in adult patients with medulloblastoma.

Adolescent↗

PubMed1993

[The neurosurgeon's role in the treatment of cerebral arteriovenous malformations. A study of a series of 100 cases and review of the literature].

The Neurosurgeons's place in the management of cerebral A.V.M.'s is discussed in the light of a personal experience and of the review of the neurosurgical literature. A personal series of 100 treated patients is presented. Patients were admitted between 1985 and April 1992. Two groups are considered: the first group including 52 patients treated before the availability of radiosurgery (1985-1988), and the second group including 48 patients treated afterwards (1989-1992). A.V.M.'s were classified in five grades according to the Spetlzer's Grading System. Three techniques of treatment were used: Surgical Resection, Intravascular Embolization (cyanoacrylate) and Radiosurgery (linear accelerator). These three techniques were used either alone or in association, giving four types of management: surgical resection alone, embolization and resection, embolization alone, and radiosurgery (alone, or after embolization or after surgical resection). From 1989 on, the availability of radiosurgery was responsible for the diminution of the "embolization and resection" group, which until then was predominantly used, for the low-grade A.V.M.'s (I.II.III) and for the high grade A.V.M.'s (IV.V) as well. Overall, for the low grade A.V.M.'s, the treatment of choice was the surgical resection (79% of cases), with a preoperative embolization in one half of these cases; the other A.V.M.'s were irradiated, with various combinations. For the high-grade A.V.M.'s, the treatment of choice was the intravascular embolization (95% of cases), either alone, or followed by exeresis (45%) or radiosurgery (9%). Results were evaluated in terms of deterioration due to treatment, in five groups: no deterioration (59%), minor deterioration (20%), long-lasting deficit (10%), major deterioration (5%) and death (6%). Overall, results improved after 1989: favourable outcome (no deterioration and minor deterioration) increased from 67% to 90%. Results were not related to the patient's age. More favourable results were obtained for low grade A.V.M.'s (93%) than for high grade A.V.M.'s (60%). For the low grade A.V.M.S. the evolution form 1989 on (favourable outcome increasing from 89% to 96%) occurred with the suppression of death cases. For the high grade A.V.M.'s, the evolution from 1989 on (favourable outcome increasing from 46% to 78%), occurred with the decreasing of the deficit cases. The angiographic eradication was strongly related to the management: 95% of complete eradication after surgical resection and 5% only after embolization alone. Concerning the results in irradiated cases, the follow-up is not long enough. The review of the neurosurgical literature since 1972 demonstrates progressive modifications in the therapeutic attitude as regards A.V.M.'s. The surgical management which was predominantly used at the beginning gave progressively way to a combined management, with a combination of embolization, surgery, and lately radiosurgery.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1993

[Teflon wrapping in cerebral aneurysm surgery. A technical note].

Wrapping is a well-known alternative technique when clipping the aneurysm is by no means possible or when it seems necessary to complete an imperfect clip. In 22 operated cases of intracranial aneurysm, we recently experienced pledgets of Teflon arranged and then fixed by drops of fibrin sealant. We used this technique in the following operative circumstances: to reinforce the ectatic base of the clipped aneurysm (11 cases); to wrap a pre-aneurysmal ectasia distant from the ruptured aneurysm (5 cases); to minimize the compression due to the clip to an adjacent cranial nerve or artery (6 cases). So far no complication was noted in relation to this technique. We then propose this technique of wrapping or interposing Teflon as an alternative to the other well-known techniques using autogenous tissue, gelatin sponge, cotton or other synthetic coatings or glue. Up to now, no known material received a worldwide approval for its complete innocuity and/or efficiency. Nowadays, in neurosurgical microvascular decompression and in cardiovascular surgery Teflon is widely and satisfactorily used. Its biologic tolerance is known to be good. This may apply in this new indication, and we would like recommend its practical use. However, for reliability and safety, there is an obvious need for a long-term clinical follow-up and an experimental controlled study as well.

Constriction↗

PubMed1992

Surgical management of unruptured intracranial aneurysms. Personal experience with 37 cases and discussion of the indications.

The authors report a series of 37 cases of unruptured aneurysms, admitted and operated upon over a 5 year period (1985-1990), which represents an incidence of 18% of the total number of aneurysm patients operated upon during this period. These unruptured aneurysms were discovered in 4 types of circumstances: 1) Associated with a ruptured aneurysm but treated in a second procedure (9 cases); 2) After a transient ischaemic attack (6 cases); 3) After a cerebral haemorrhage of a different origin (3 cases), 4) After the onset of various neurological symptoms other than SAH (19 cases). Giant aneurysms (over 2.5 cm in diameter) are excluded from this series. Overall these 37 patients harboured 52 aneurysms, and 1 patient was operated upon on both sides. 27 aneurysms (52%) were located on the right side, 15 (29%) on the left side, and 10 (19%) on the midline. In the immediate post operative period, 1 patient died (2.6%) and 8 patients (21%) presented various complications. The outcome at 6 months was: death 2.6%, moderately disabled 8%, good recovery 89%. The arguments in favour of, or against, the surgical treatment of unruptured aneurysms are discussed in view of the literature. In favour of prophylactic surgery are: 1) The rather poor overall outcome following aneurysm rupture (including deaths before admission); 2) The rather good outcome of surgery in published series of unruptured aneurysms. The data of the natural history of the unruptured aneurysm are more questionable: in this view, surgery seems to be recommended in young patients with an easily accessible aneurysm and being in a good clinical condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Fenestration of the middle cerebral artery and aneurysm at the site of the fenestration.

The authors report the case of a patient who presented a ruptured aneurysm of the anterior communicating artery and an unruptured aneurysm of the middle cerebral artery arising at the site of a fenestration of the MCA. The fenestration was undiagnosed on the preoperative angiogram but discovered during the surgery carried out for clipping of the aneurysms. In the literature, cases of fenestration of the MCA are sporadically reported and are incidental findings; an aneurysm may be associated on an artery other than the fenestrated MCA; an aneurysm arising at the site of the MCA fenestration is a very rare occurrence.

Aneurysm, Ruptured↗

PubMed1992

Ruptured occult arteriovenous malformation associated with an unruptured intracranial aneurysm: report of three cases.

Three patients who were admitted for intracranial hemorrhage are reported. Cerebral angiography demonstrated an aneurysm arising from the middle cerebral artery bifurcation. No other malformation was visible either on the computed tomographic scan or on angiography. The diagnosis was ruptured middle cerebral artery aneurysm with intracerebral hematoma. At surgery, there was no blood in the sylvian fissure and the aneurysm was not ruptured. Evacuation of the hematoma and thorough exploration of the cavity led to the discovery and resection of a small vascular anomaly typical of an arteriovenous malformation responsible for the hemorrhage. Occult vascular malformations and the association of aneurysm with arteriovenous malformations are discussed. In these 3 patients, the coexistence of these two malformations could be related to a common congenital abnormality.

Adult↗

PubMed1992

[Ruptured intracranial aneurysm. Modification of the surgical method based on the state of consciousness and age of patients. Personal experience with 468 patients admitted during 2 periods (1972-84 and 1985-89)].

The management of the ruptured intracranial aneurysm (clinical grade I to IV only) is studied in a series including 140 patients admitted from 1985 through 1989, in which selected patients were submitted to early surgery and other patients were postponed for delayed surgery. The results are compared to those of an earlier series including 328 patients admitted from 1972 through 1984, for which the general attitude was the delayed surgery: in the later series; the selection for the timing of surgery was based on two main parameters: the clinical status and the patient's age. When we compare both series, the overall management results demonstrate an improvement of 10% of satisfactory results and a decrease of 10% in the death rate in favour of the later series; for the surgical results, the figures are respectively 6% and 5% in favour of the later series. The relationship between age and outcome shows a considerable improvement: over 50 years of age, we observed plus 25% of satisfactory results and minus 22% in death in favour of the later series. Similarly, the relationship between state of consciousness and outcome, demonstrated a great improvement: for drowsy and stuporous patients the figures are respectively plus 22% and minus 21% in favour of the later series. When we consider the later series alone, the patients were admitted at 4 intervals of time from S.A.H. (D0-3, D4-6, D7-15, D16 and over). The most favorable outcome was observed for those patients admitted late (after D7) and already stabilized.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Magnetic resonance imaging contribution to the diagnosis of spinal cord compression by a subdural arachnoid cyst.

A case of subdural arachnoid cyst of the thoracic spine was studied by magnetic resonance imaging (MRI), myelography and CT myelography. Myelography and especially CT myelography suggested the diagnosis; MRI established it, showing the communication between the cyst and the subarachnoid space. Final characterization was based on surgical findings and pathological examination.

Arachnoid Cysts↗

PubMed1991

Management of the ruptured intracranial aneurysm--early surgery, late surgery, or modulated surgery? Personal experience based upon 468 patients admitted in two periods (1972-1984 and 1985-1989).

The management of the ruptured intracranial aneurysm is studied in two consecutive series: an earlier series, including 328 patients admitted from 1972 through 1984, for which the general attitude was delayed surgery, and a later series, including 140 patients admitted from 1985 through 1989, in which selected patients were submitted to early surgery and other patients were postponed for delayed surgery, according to two main parameters: the clinical status and the patient's age. When we compare both series, the overall management results demonstrate an improvement of 10% of satisfactory results and a decrease of 10% in the death rate in favour of the later series; for the surgical results, the figures are respectively 6% and 5% in favour of the later series. The relationship between age and outcome shows a considerable improvement: over 50 years of age, we observed plus 25% of satisfactory results and minus 22% in death in favour of the later series. Similarly the relationship between state of consciousness and outcome, demonstrated a great improvement; for drowsy and stuporous patients the figures are respectively plus 22% and minus 21% in favour of the later series. When we consider the later series alone, the patients were admitted at 4 intervals of time from SAH (D0-3, D4-6, D7-15, D16 and over). The most favourable outcome was observed for those patients admitted late (after D7) and already stabilized. Patients admitted early (D0-3) were operated on at four intervals of time (D0-3, D4-6, D7-15, D16 and over). The most favourable outcome was observed for those patients operated on early (D0-3) or very late (D16 and over). For patients admitted early and being under 50 years of age, the results were: satisfactory 92%, poor 2.5%, death 5%. The relationship between age and outcome shows a very small difference between patients under or over 50 years of age. The relationship between level of consciousness and outcome still demonstrates an appreciable difference: plus 22% (satisfactory) and minus 7% (death) in favour of alert patients. Rebleeding was the cause of disability or death in 2.8% of the overall later series and 2.7% of patients admitted early; as for vasospasm the figures are respectively 4.2% and 5.4%. These results are presented with reference to those of the Co-operative Study. After this experience, the author's general attitude for the timing of surgery is neither systematic early surgery, nor systematic delayed surgery, but modulated surgery, based upon the evaluation of the operative risk: minor risk, major risk, intermediate risk.(ABSTRACT TRUNCATED AT 400 WORDS)

Follow-Up Studies↗

PubMed1991

The carotid endarterectomy: experience with 260 cases and discussion of the indications.

During 1978 to 1989, 235 patients were operated upon with 260 procedures for cervical carotid endarterectomy. The patients were classified according to the presence or absence of ischaemic symptomatology, and for symptomatic patients, according to the reversibility or persistence of ischaemic symptoms. So the selection of patients was: reversible ischaemia 46%, stroke 29%, asymptomatic patients 25%. In the stroke group, no patient was operated on as an emergency, the endarterectomy was only performed after stabilization of the clinical state. Three subgroups were included in patients operated on for asymptomatic carotid stenosis: casual discovery 40%, treatment of the second carotid artery (previous endarterectomy for symptomatic contralateral stenosis) 34%, and treatment of the second carotid artery (previous ECIC by-pass for contralateral carotid occlusion) 26%. All patients were operated upon after angiographic exploration (femoral catheterisation in most cases), and after cerebral CT scan. The surgical technique included general anaesthesia, systematic shunting, endarterectomy after longitudinal arteriotomy, closure without patch. The operating microscope has been used since 1985. The surgical results were studied in terms of uneventful postoperative course (87%), reversible complications (8%) and long lasting complications (5%). The long lasting complications were of local origin (1%), of neurological origin (2%), of general origin (1%). Overall the operative outcome at 6 months was: return to previous clinical state 95%, neurological sequelae 2%, death 3%. In the patients operated on for asymptomatic carotid stenosis the overall outcome was: previous clinical state 97%, death 3%. The legitimacy of carotid endarterectomy procedure is discussed in relation to some recent pertinent literature.

Adult↗

PubMed1991

Extracranial surgery for vertebro-basilar ischaemia (experience of 8 cases).

Atheromatous lesions of the proximal vertebral artery and the subclavian artery may lead to ischaemic manifestations, occasionally with severe consequences in the vertebro-basilar territory. These transient ischaemic attacks are most often caused by haemodynamic insufficiency rather than thrombo-embolic complications addressed by anticoagulant and antiaggregant treatments. In this study, 8 cases of vertebro-basilar ischaemia (VBI), secondary to subclavian and proximal vertebral artery lesions, are reported. Surgical techniques, subclavian-to-subclavian artery by-pass (5 cases) and vertebral to common carotid artery transposition (3 cases) are described with their respective results. Through a review of the literature, the various operative modalities are discussed in the different pathological conditions of the proximal extracranial vertebro-basilar disease. It appears that the subclavian to subclavian artery by-pass as well as the vertebral-to-common carotid artery transposition are safe surgical procedures with strikingly low morbidity and mortality rates. The widely achieved relief of the ischaemic episodes, undoubtedly makes this surgery an alternative to medical treatment.

Aged↗

PubMed1991

[Cervical carotid endarterectomy. Evaluation of a 12 years' experience (260 operations)].

From 1978 to 1989, 235 patients were operated upon with 260 procedures for cervical carotid endarterectomy. The patients were classified according to the presence or absence of ischemic symptomatology, and for symptomatic patients, according to the reversibility or persistence of ischemic symptoms. So the selection of patients was: reversible ischemia 46%, stroke 29%, asymptomatic patients 25%. In the stroke group, no patient was operated on in emergency, the endarterectomy was performed after stabilization of the patients. Three subgroups were included in patients operated on for asymptomatic carotid stenosis: casual discovery 40%, treatment of the second carotid artery (previous endarterectomy for symptomatic controlateral carotid artery) 34%, and treatment of the second carotid artery (previous ECIC Bypass for controlateral occluded artery) 26%. All patients were operated upon after angiographic exploration (femoral catheterism in most cases), and after cerebral CT Scan. The surgical technique included general anesthesia, systematic shunting, endarterectomy after longitudinal arteriotomy, closure without patch. The operative microscope has been used since 1985. The operatives results were studied in terms of uneventful post-operative course (87.3%), reversible complications (8.1%) and long lasting complications (4.6%). The long lasting complications were of local origin (1.1%), of neurological origin (2.3%), of general origin (1.2%). Overall the operative results at 6 months were: return to previous clinical state 95.4%, neurological sequellae 1.5%, deaths 3.1%. In patients operated on for asymptomatic carotid stenosis the overall results were: previous clinical state 97%, death 3%. The legitimy of carotid endarterectomy procedure is discussed in view of some recent pertinent literature.

Adult↗

PubMed1990

Association of cerebral arteriovenous malformation and cerebral aneurysm. Diagnosis and management.

Between 1979 and 1989, 7 patients were admitted, with cerebral arteriovenous malformations (AVM) and associated aneurysms (7% of the AVM patients and 2% of the aneurysm patients admitted during the same period). 6 of these patients were admitted because of an intracranial haemorrhage (in 3 of them the AVM, angiographically occult, was discovered at surgery). The last patient was referred for seizures. Preoperatively it was supposed that the haemorrhage was related to the aneurysm in 3 cases, and to the AVM in 3 cases. But surgery allowed one to correct this supposition. Haemorrhage was due to AVM rupture in all 6 cases, and no aneurysm had ruptured. Overall three situations were demonstrated in this series: aneurysm and occult AVM (3 cases); AVM and independent aneurysm in the same area (2 cases); large AVM and aneurysm on a feeding artery (2 cases). All 6 patients admitted for haemorrhage were operated upon, at one operation in 5 of them. Both the malformations were excluded in these six patients. For the patient admitted for seizure, intra-vascular embolization of the AVM was performed, the aneurysm was not treated. The pathogenesis of the association AVM-aneurysm is discussed. In the authors' opinion, haemodynamic relationship should be considered in two cases (large AVM and aneurysm on a feeding vessel). For the other 5 cases, both the AVM and the coexisting aneurysm may be the end-result of a common congenital vascular malformation syndrome.

Adult↗

PubMed1990

[Multiple intracranial aneurysms: discussion of the therapeutic management of a case].

The authors report the case of a 57-year-old, right-handed female who experienced a sudden acute headache, followed by a period of confusion and fever. Over the next week she developed language disturbances. No diagnosis was established. Three weeks later she was referred to the neurologist, complaining of a right frontal headache. The C.T. scans with and without contrast enhancement were suggestive of an aneurysm in each sylvian fissure. The angiography disclosed the presence of four aneurysms: a large left M.C.A. aneurysm, a larger right M.C.A. aneurysm, an aneurysm on the anterior communicating aneurysm and a small right M.C.A. aneurysm located more distally. The left M.C.A. aneurysm was presumably ruptured and responsible for the initial symptoms. The right M.C.A. aneurysms was apparently unruptured, but accounted for the persistent right headache. The other two aneurysms were thought to be asymptomatic. The left M.C.A. was operated first. Blood in the sylvian fissure confirmed the earlier rupture. Two weeks later, the three other aneurysms were surgically treated, via the same right pterional approach. No sign of hemorrhage was found on the right side. The post-operative angiogram demonstrated the disappearance of all four aneurysms. Three months later, the patient was able to resume her previous occupations and clinically, she demonstrated no sign of psychological or intellectual disturbances. The management of multiple and bilateral cerebral aneurysms is discussed, as well as the management of asymptomatic aneurysms.

Female↗

PubMed1990

[The same question for the past 20 years: when should a ruptured intracranial aneurysm be surgically treated? (Experience with 434 cases)].

The timing of surgery for the ruptured aneurysm (SAH) remains controversial. After the period of delayed surgery, the early surgery is now more and more frequently advocated. This paper, study our experience in aneurysm surgery in two different periods, considering only patients admitted in grades I to IV, excluding grade V patients (deep coma, decerebration). During the former period (1972-1984) 328 patients were admitted and considered for delayed surgery, usually during the second week following SAH. 94.5% of patients were operated upon. 5.5% patients died before surgery, from ischemia (3%) or from rebleeding (2.5%). 38.5% were admitted between (D.O-D3) after SAH, D.O being the day of SAH. Only 5.7% were operated upon between D.O-D3. The higher peak of surgery was during the second week (41.8%) and during the third week (39.2%). During the later period (1985-1988) 106 patients were admitted, 50% of them between D.O and D3 after SAH. Every patient was operated upon. The patients admitted between D.O and D3 were operated upon as follows: between D.O and D3 = 32.1%, between D4 and D6 = 22.6%, between D7 and D15 = 34%, after D16 = 11.3%. The analysis of these sub-groups demonstrates that the distribution was related to the age and clinical status. Patients being awake and under 50 years of age were considered for early surgery. Patients being obnubilated or stuporous, and over 50 years of age were planned for delayed surgery. Angiographic spasm and extension of blood in CT Scan were taken in consideration to a lesser degree.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗