Artikel
Current management of aneurysmal subarachnoid hemorrhage in Germany: a survey of practice among 100 neurosurgical departments
Die gegenwärtige Behandlung aneurysmatischer Subarachnoidalblutungen in Deutschland: Ergebnisse einer Umfrage unter 100 neurochirurgischen Kliniken
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
To assess the status quo of clinical management in patients with ruptured intracranial aneurysms in Germany. In addition to preferences in vascular treatment (i.e. surgical vs. endovascular), the choice of diagnostics and treatment options in the pre- and post-operative/interventional phase is emphasized.
Methods
A postal survey was conducted between March and September 2004. Participants were representatives of neurosurgical departments in Germany (n=130).
Results
The overall response rate was 77% (n=100). Pre-operative assessment was standardised by computed tomography and conventional angiography. Endovascular treatment options were used in 71% of all responding centres. 63% of all ruptured aneurysms were treated surgically. Anterior circulation aneurysms were operated in 91%. In contrast, endovascular treatment was preferred for posterior circulation aneurysms. Acute posthemorrhagic hydrocephalus was treated routinely by external ventricular drainage (97%). Doppler-sonography, monitoring of cerebral perfusion pressure and electrophysiology were used by a significant number of respondents. Specific treatment of SAH patients included calcium-antagonists (69%), glucocorticosteroids (34%) and hemorrheologic agents (29%). Delayed ischemia was treated by prophylactic and/or therapeutic volume expansion, induced hypertension and hemodilution (40 and 20%, respectively).
Conclusions
In Germany, clinical management of SAH patients is standardized in preoperative diagnostics, intensive care unit (ICU) monitoring and post-operative treatment. Preferred treatment for anterior circulation aneurysms is surgical, while endovascular treatment options are preferentially used in the posterior circulation. This survey should help to compare the current treatment status with previously published guidelines, to analyze future developments in the management of SAH and finally in identifying new standards in both national and international level.