PubMed · 8111979
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D Samson. 1993. Aneurysm perspective.. https://pubmed.ncbi.nlm.nih.gov/8111979/
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BACKGROUND AND PURPOSE: After a craniotomy for cerebral aneurysm, postoperative mortality can be significant. Previous studies have shown that hospitals performing frequent high-risk procedures (such as coronary artery bypass) have a lower mortality than hospitals where these procedures are performed infrequently. METHODS: The Statewide Planning and Research Cooperative System of the New York State Department of Health reviewed all discharges in New York State from 1987 through 1993 for the diagnoses of subarachnoid hemorrhage and/or cerebral aneurysm and for patients with the procedure code for craniotomy for ruptured or unruptured cerebral aneurysm. In-hospital mortality and length of stay were examined in relation to the volume of craniotomies for aneurysm performed at each individual hospital. RESULTS: A total of 15,376 discharges for subarachnoid hemorrhage and 5638 craniotomies for aneurysm were tabulated in 208 hospitals. For all patients who underwent craniotomy for ruptured cerebral aneurysm (n = 4034), there was a 43% (95% confidence interval, 29% to 57%) reduction in mortality rate in hospitals performing more than 30 craniotomies per year for cerebral aneurysm compared with hospitals performing less surgery (8.8% versus 15.5%, P < .0001). For all patients who underwent craniotomy for unruptured cerebral aneurysm (n = 1604), there was an identical 43% (95% confidence interval, 14% to 73%) reduction in mortality in hospitals performing more than 30 craniotomies per year for cerebral aneurysm (4.6% versus 8.1%, P = .0087). CONCLUSIONS: Hospitals that frequently perform aneurysm operations have lower mortality rates for patients undergoing craniotomy for cerebral aneurysm than hospitals that perform fewer operations.
OBJECTIVE: To determine the outcome of patients with subarachnoid haemorrhage and whether delays in their diagnosis and referral have been reduced over a 15-year period. DESIGN: A 15-year retrospective study of patients admitted to a tertiary neurosurgical unit between 1977 and 1992. SETTING: The Royal North Shore Hospital, Sydney. PATIENTS: 511 patients admitted with subarachnoid haemorrhage from ruptured intracranial aneurysms. RESULTS: Of 486 patients with at least a six-month follow-up, 66% made a good recovery and 19% died. Outcome was significantly influenced by the neurological condition of the patient at admission (P < 0.0001). There was no significant difference in the relative proportions of patients transferred late (three or more days after onset of symptoms) when those admitted before and after 1986 were compared. CONCLUSION: Delayed diagnosis and referral remain the major preventable problems in the management of patients with aneurysmal subarachnoid haemorrhage.
An exploratory laparotomy of a four-year-old red Holstein cow with signs of abdominal discomfort revealed a painful pulsating mass in the cranial part of the abdomen. The cow died suddenly. A post mortem examination showed that a ruptured aneurysm of the cranial mesenteric artery had been the cause of death.