By Keiji Sano M.D., D.M.Sc., F.A.C.S. (Hon.), Takao Asano M.D., D.M.Sc., Akira Tamura M.D., D.M.Sc. (auth.)
During fresh years, significant advances in surgical concepts, diagnostic tools, anesthesia and adjunctive therapy within the care of sufferers with subarachnoid hemorrhage were completed. however, the general end result of sufferers with SAH can't be considered as passable. the 1st a part of the ebook concentrates at the pathogenetic mechanisms underlying vasospasm and edema, the vital factors of negative final result. fresh development within the box of membrane lipid metabolism has allowed the matter to be approached from a wholly new viewpoint. the prospective participation of unfastened radicals, membrane lipids and eicosanoids is carefully mentioned. the second one half good points the issues of functional administration of SAH sufferers. Timing and indication of surgical procedure of aneurysms and the surgical thoughts are defined in detail.
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Additional resources for Acute Aneurysm Surgery: Pathophysiology and Management
1979, Lobato et al. 1980), hemoglobin (Miyaoka et al. 1976, Osaka 1977, Sonobe and Suzuki 1978, Ozaki and Mullan 1979, Tanishima 1980, Wellum et al. 1982), thrombin (White et al. 1980), fibrin degradation products (Ito 1980), potassium (Wilkins and Levitt 1971, Shiguma 1982), classical prostaglandins (Yamamoto et al. 1972, Handa et al. 1974, Pickard et al. 1975, White et al. 1979, Maeda et al. 1982, White and Hagen 1982, Pickard and Walker 1984), thromboxane A 2 and prostacyclin (Ellis et al. 1977, Asano et al.
In 1966, Kagstrom et al. reported that, as a rule, angiography performed during the first few days after the initial bleeding will show no spasm and that spasm is most intense during a period from the sixth to the twelfth day after the bleeding. Wilkins et al. also reported that of the 19 patients who had angiography within 24 hours after SAH, none showed evidence of spasm (Wilkins et al. 1968). This finding has then been supported by succeeding reports (Gurdjian et al. 1969, Bergvall et al. 1973, Odom 1975, Wilkins 1976) and became to be widely accepted.
The reports on the result of carotid ligation for cerebral aneurysms published around 1940 comprised of cases in which the diagnosis was mainly made either by operation or localizing symptoms. However, some of those reports are of interest, because into them, the origin of the concept of cerebral vasospasm as well as the origin of later controversies concerning vasospasm can be traced. Jefferson reported on the clinical manifestations and treatment of the saccular aneurysms of the internal carotid artery in the cavernous sinus (Jefferson 1938).