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CONTROVERSIES IN THE SURGICAL TREATMENT OF RUPTURED INTRACRANIAL ANEURYSMS: THE FIRST ANNUAL J. LAWRENCE POOL MEMORIAL RESEARCH SYMPOSIUMCONTROVERSIES IN THE MANAGEMENT OF CEREBRAL ANEURYSMS

Komotar, Ricardo J. M.D.; Zacharia, Brad E. B.S.; Mocco, J M.D.; Connolly, E. Sander Jr. M.D.

Neurosurgery:
doi: 10.1227/01.neu.0000316006.26635.b0
J. Lawrence Pool Symposium
Abstract

THE MANAGEMENT OF aneurysmal subarachnoid hemorrhage has evolved over time, including the use of the microscope for aneurysm clip application, improved imaging modalities, endovascular methods for aneurysm treatment, dedicated neurointensive care units, and more aggressive therapy for cerebral vasospasm. Although these advancements have reduced the morbidity and mortality associated with aneurysmal subarachnoid hemorrhage, outcomes for this patient population continue to leave much room for improvement. This work highlights controversial adjuvant techniques, maneuvers, and therapies surrounding the surgical treatment of ruptured cerebral aneurysms that currently lack a consensus opinion. These treatments include centralized care in high-volume centers, as well as the use of antifibrinolytic therapy, routine cerebrospinal fluid diversion, intraoperative hypothermia, temporary clip application, neuroprotective drugs, intraoperative angiography, and decompressive hemicraniectomy. Although definitive answers will only be possible through future multicenter collaboration, we review the controversy surrounding these adjuncts and report the consensus opinion from a highly experienced audience.

Author Information

Department of Neurological Surgery, Columbia University, New York, New York

Reprint requests: Ricardo J. Komotar, M.D., Department of Neurological Surgery, Neurological Institute of New York, Columbia University Medical Center, 710 West 168th Street, Box 199, New York, NY 10032. Email: rjk2103@columbia.edu

Received, April 4, 2007.

Accepted, June 18, 2007.

Copyright © by the Congress of Neurological Surgeons