Vascular Surgery


Grade

Clinical symptoms

I

Asymptomatic or mild headache with minimal nuchal rigidity

II

Moderate or severe degree of headache and nuchal rigidity and no neurologic deficit other than cranial nerve palsy

III

Sleepiness, confused, and mild focal neurologic deficit

IV

Obtunded, stupor, moderate hemiparesis or hemiplegia, and autonomic dysfunction

V

Deep coma, decerebration rigidity, and severe autonomic dysfunction


Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28(1):14–20







  • Unruptured aneurysms: These are usually incidental findings in asymptomatic patients being scanned for other pathologies. If symptomatic, focal neurological deficits may be seen due mostly their mass effect. For example, aneurysms in the carotid siphon may cause a peripheral third cranial nerve deficit with anisocoria.



29.3 Indications for Surgery






  • Ruptured aneurysm(s): Treatment is indicated within at least 72 h after hemorrhage. Several factors help decide whether the treatment is endovascular or surgical. Factors include the clinical condition of the patient, aneurysmal location, and type and size of the aneurysms.


  • Unruptured aneurysm(s): Treatment can be deferred to when there are more favorable clinical conditions. Aneurysms above 7 mm are given highest priority [1, 2].


29.4 Objectives of the Surgery






  • To isolate an aneurysm from the arterial circulation in order to minimize/eliminate the risk of future rupture with associated subarachnoid hemorrhage.


  • To prevent further hemorrhage in ruptured aneurysms [2, 3].


29.5 Surgical Approach(es)


The decision whether endovascular treatment or whether it is surgical approach is largely based upon topographic criteria (where the aneurysm is located):

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Dec 24, 2017 | Posted by in NEUROSURGERY | Comments Off on Vascular Surgery

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