Aneurysmal Subarachnoid Hemorrhage

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Subarachnoid hemorrhage involves bleeding into the subarachnoid space. This may be caused by trauma or result from a vascular pathology. Here, the focus is specifically on subarachnoid hemorrhage caused by a ruptured aneurysm. Aneurysmal subarachnoid hemorrhage is a serious condition, with approximately 65% of patients dying from the initial subarachnoid hemorrhage1. Even among patients who survive subarachnoid hemorrhage without neurological deficits, only 46% recover fully, and only 44% are able to return to their former occupation2.

Cause

The cause of aneurysmal subarachnoid hemorrhage is rupture of an aneurysm. These potential vascular weak points occur in approximately 1-2% of the population. Aneurysms occur particularly at bifurcations or trifurcations of blood vessels. Depending on the location, size, and risk factors, the annual risk of rupture varies considerably.

Aneurysm rupture risk
Risk of rupture in intracranial aneurysms.

Coiling vs. Clipping

Endovascular treatment options have become significantly more refined in recent years. With regard to short-term outcome, endovascular treatment using coiling has been shown to provide a better advantage.

Intraoperatively, in cases of aneurysms in difficult locations, cardiac function can be temporarily switched off using Adenosine3 or an inserted Pacemaker 4 in order to reduce aneurysm pulsation and facilitate faster clipping.

Rapid intraventricular pacing
Illustration of the hemodynamic course during rapid pacing

References

    1. Tew JM, Thompson RA, Green JR. In: Guidelines for Management and Surgical Treatment of Intracranial Aneurysms. Controversies in Neurology. New York: Raven Press; 1983:139-154. ↩ ↩

    2. Wirth FP. Surgical Treatment of Incidental Intracranial Aneurysms. Clin Neurosurg. 1986;33:125-135 ↩ ↩

    3. Guinn, Nicole R., et al. "Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective review." Journal of neurosurgical anesthesiology 23.1 (2011): 35-40. ↩ ↩

    4. Saldien, Vera, et al. "Rapid ventricular pacing for flow arrest during cerebrovascular surgery: revival of an old concept." Operative Neurosurgery 70.suppl_2 (2012): ons270-ons275. ↩ ↩

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    • Text changed: “Subarachnoid hemorrhage is bleeding into the subarachnoid space. This may be caused by trauma or by a vascular pathology. This article focuses specifically on subarachnoid hemorrhage caused by a ruptured [aneurysm](\/lexikon\/aneurysma). Aneurysmal subarachnoid hemorrhage is a severe clinical condition, with approximately 65% of patients dying from the initial subarachnoid hemorrhage[^3]. Even among patients who survive subarachnoid hemorrhage without neurological deficits, only 46% recover fully, and only 44% are able to return to their previous occupation[^4].”“Subarachnoid hemorrhage involves bleeding into the subarachnoid space. This may be caused by trauma or result from a vascular pathology. Here, the focus is specifically on subarachnoid hemorrhage caused by a ruptured [aneurysm](\/lexikon\/aneurysma). Aneurysmal subarachnoid hemorrhage is a serious condition, with approximately 65% of patients dying from the initial subarachnoid hemorrhage[^3]. Even among patients who survive subarachnoid hemorrhage without neurological deficits, only 46% recover fully, and only 44% are able to return to their former occupation[^4].”
    • Text changed: “The cause of aneurysmal subarachnoid hemorrhage is rupture of an aneurysm. These potential vascular weak points occur in approximately 1-2% of the population. Aneurysms occur particularly at bifurcations or trifurcations of vessels. Depending on the location, size, and risk factors, the annual risk of rupture varies considerably.”“The cause of aneurysmal subarachnoid hemorrhage is rupture of an aneurysm. These potential vascular weak points occur in approximately 1-2% of the population. Aneurysms occur particularly at bifurcations or trifurcations of blood vessels. Depending on the location, size, and risk factors, the annual risk of rupture varies considerably.”
    • Text changed: “Endovascular treatment options have been refined considerably in recent years. With regard to short-term outcome, endovascular treatment using coiling has been shown to be more advantageous.”“Endovascular treatment options have become significantly more refined in recent years. With regard to short-term outcome, endovascular treatment using coiling has been shown to provide a better advantage.”
    • Text changed: “Intraoperatively, in cases of aneurysms with difficult locations, cardiac function can be temporarily stopped using Adenosine[^1] or an inserted pacemaker [^2] in order to reduce aneurysm pulsation and facilitate faster clipping.”“Intraoperatively, in cases of aneurysms in difficult locations, cardiac function can be temporarily switched off using Adenosine[^1] or an inserted Pacemaker [^2] in order to reduce aneurysm pulsation and facilitate faster clipping.”

    Article created on · Alaric Steinmetz

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