gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Differences in the management of aneurysmal subarachnoid haemorrhage in Germany: further analyses from a survey of practice among 100 neurosurgical departments

Unterschiede in der Behandlung aneurysmatischer Subarachnoidalblutungen in Deutschland: weitere Ergebnisse einer Umfrage unter 100 neurochirurgischen Kliniken

Meeting Abstract

  • corresponding author O. W. Sakowitz - Abteilung für Neurochirurgie, Universitätsklinikum Heidelberg
  • D. Vucak - Abteilung für Neurochirurgie, Universitätsklinikum Heidelberg
  • K. L. Kiening - Abteilung für Neurochirurgie, Universitätsklinikum Heidelberg
  • A. W. Unterberg - Abteilung für Neurochirurgie, Universitätsklinikum Heidelberg

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc10.05.-10.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0135.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Sakowitz et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

To assess differences in the management of aneurysmal subarachnoid haemorrhage (SAH) in Germany. Different groups were identified according to responds of a conducted postal survey.

Methods

A postal survey was conducted between March and September 2004. Participants were representatives of neurosurgical departments in Germany (n=130). The response rate was 77% (n=100). Respondents, who indicated (A) high case-loads or (B) preference for endovascular treatment options, were identified. Arbitrary thresholds of more than 50 SAH cases treated per year and more than 50% endovascular treatments were chosen, respectively. Subgroup analyses were done and Fisher’s exact test was used to prove statistical significance (p<0.05).

Results

In 17 of 100 respondents, an overlap between high-volume centres and centres with preference for endovascular treatment option was encountered. (A) Forty-three high-volume institutions were identified. A higher intensive care capacity, utilization of objective scales and protocols in the treatment of vasospasm and follow-up became evident. Poor-grade SAH patients tend to be treated earlier. Endovascular treatment was more likely available and more likely to be used, even in anterior-circulation aneurysms. Sophisticated monitoring techniques, i.e. tissue oximetry and pulse-integrated cardiac output measurement, are used in more than 50% in this group. (B) A total 37 of respondents with preference for endovascular treatment options for SAH was identified. More than 95% indicated frequent use of endovascular treatment options for anterior circulation aneurysms. Intraoperative use of electrophysiological monitoring was encountered more frequently. (A/B) In both groups, occasional use of cerebral bypass surgery, induced cardiac arrest and cisternal thrombolysis, as well as endovascular treatment of cerebral vasospasm was frequently indicated.

Conclusions

High-volume centres are more likely to specialize in standardization of care and intensive care treatment. In centres with preference for endovascular treatment this is more or less restricted to the method of aneurysm obliteration. Future directives in the clinical management of SAH will have to take these differences into account.