Aneurysmal Subarachnoid Hemorrhage
Last edit by Alaric Steinmetz on
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. Aneurysmal subarachnoid hemorrhage is a severe clinical 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 previous 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 vessels. Depending on the location, size, and risk factors, the annual risk of rupture varies considerably.
Coiling vs. Clipping
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.
Intraoperatively, in cases of aneurysms with difficult locations, cardiac function can be temporarily stopped using Adenosine3 or an inserted pacemaker 4 in order to reduce aneurysm pulsation and facilitate faster clipping.
References
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. ↩ ↩
Wirth FP. Surgical Treatment of Incidental Intracranial Aneurysms. Clin Neurosurg. 1986;33:125-135 ↩ ↩
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. ↩ ↩
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. ↩ ↩
