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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Basis and relevance of neurosurgical end-of-life decisions

Grundlage und Relevanz neurochirurgischer "end-of-life-Entscheidungen"

Meeting Abstract

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  • corresponding author Carlo Schaller - Neurochirurgische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105 Bonn
  • M. Kessler - Neurochirurgische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105 Bonn

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.01.06

The electronic version of this article is the complete one and can be found online at:

Published: April 23, 2004

© 2004 Schaller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




To analyse the patient population prone to end-of-life-decisions as related to their clinical basis and prognostic relevance in a major neurosurgical center.


The biodata and clinical information of patients, who were subject to neurosurgical end-of-life-decisions (= the decision to stop medical and/or surgical treatment) were prospectively collected in a computerized database for a one-year period of time (09/02 - 08/03).


Out of a total of n=138, n=114 patients (52 F, 72 M) with a median age of 65 (4-94) years remained, in whom complete data acquisition was possible for further analysis. The leading diagnoses were as follows: n=30 (26.3%) traumatic brain injury, n=27 (23.7%) ICH, n=21 (18.4%) SAH, n=10 (8.8%) infarction, and n=22 (19.3%) others. Prior to the end-of-life-decisions, n=45 (39.5%) were treated surgically and n=69 (60.5%) by neurointensive care including external ventricular drainage alone. N=83 (72.8%) were cardiopulmonary stable at the time of decision making, and n=31 (27.2%) were not. N=82 had uni-/bilaterally fixed/dilated pupils (71.9%). Upon on site examination and/or CT-consultation n=24 (20.8%) were not admitted to or rejected from the service due to their grave prognosis. N=111 (97.4%) died after a median of 2 (0-9) days. N=3, in whom the end-of-life-decisions were revised, survived. Decisions to terminate further treatment were primarily made by the senior resident on call in discussion with the staff member on call (28.1%), by the responsible senior consultant/department chair (71.1%), and by an interdisciplinary ethical comitee (0.9%). Decisions were further substantiated by SSEP/MEP examinations in n=59 (51.8%) with the brain death protocol including EEG completed in n=25 (21.9%).


The performance of end-of-life-decisions must be considered daily routine for the respective neurosurgeons on call. These decisions reached a sensitivity of 97.4% for positive prediction of death. Inclusion of electrophysiological criteria in those cases, in which uncontrollable intracranial pressure and the amount of cerebral damage is the leading cause, is essential for valid analysis during situations which exert maximal professional and emotional stress onto the physicians as well as onto the patient´s relatives.