Subarachnoidalblutung: Diagnostik und therapeutische Optionen

Zusammenfassung

Die Subarachnoidalblutung ist eine schwerwiegende, häufig zum Tode führende Erkrankung. Radiologische Methoden sind für die Diagnostik unverzichtbar und für die Therapie der intrakraniellen Aneurysmen vielerorts auch schon Standard. Die folgende Arbeit gibt einen Überblick über die Wertigkeit der einzelnen radiologischen Methoden bei der Abklärung der SAB sowie über die Möglichkeiten und Grenzen der endovaskulären Therapie.

Abstract

Subarachnoid hemorrhage (SAH) is a devastating event, often with fatal outcome. Radiological methods are indispensable for the diagnosis of SAH and in many places have become the standard in the therapy of intracranial aneurysms. This article reviews the impact of radiological methods on diagnosing SAH and the capabilities and limitations of endovascular therapy.

Key words

- Subarachnoid hemmorrhage; - Aneurysm, intracranial; - Interventional procedures; - Brain, CT; - Brain, hemorrhage

Literatur

• 1 Auer L M, Schneider G H, Auer T. Computerized tomography and prognosis in early aneurysm surgery.  J Neurosurg. 1986;  65 (2) 217-221
• 2 Brilstra E H, Hop J W, Rinkel G J. Quality of life after perimesencephalic haemorrhage.  J Neurol Neurosurg Psychiatry. 1997;  63 (3) 382-384
• 3 Brilstra E H, Rinkel G J, van der Graaf Y, van Rooij W J, Algra A. Treatment of intracranial aneurysms by embolization with coils: a systematic review.  Stroke. 1999;  30 (2) 470-476
• 4 Doerfler A, Wanke I, Egelhof T, Dietrich U, Asgari S, Stolke D, Forsting M. Aneurysmal rupture during embolization with Guglielmi detachable coils: causes, management, and outcome.  Am J Neuroradiol. 2001;  22 (10) 1825-1832
• 5 Guglielmi G, Vinuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience.  J Neurosurg. 1991;  75 8-14
• 6 Hadjivassiliou M, Tooth C L, Romanowski C A, Byrne J, Battersby R D, Oxbury S, Crewswell C S. et al . Aneurysmal SAH: cognitive outcome and structural damage after clipping or coiling.  Neurology. 2001;  56 (12) 1672-1677
• 7 Hashimoto H, Iida J, Hironaka Y, Okada M, Sakaki T. Use of spiral computerized tomography angiography in patients with subarachnoid hemorrhage in whom subtraction angiography did not reveal cerebral aneurysms.  J Neurosurg. 2000;  92 (2) 278-283
• 8 Hunt W F, Hess R M. Surgical risk as related to time of intervention in the repair of intracranial aneurysms.  J Neurosurg. 1968;  28 14-20
• 9 Kalavakonda C, Sekhar L N, Ramachandran P, Hechl P. Endoscope-assisted microsurgery for intracranial aneurysms.  Neurosurgery. 2002;  51 (5) 1119-1126 , discussion 1126 - 1127
• 10 Kassell N F, Torner J C, Haley E C, Jane J A, Adams H P, Kongable G L. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results.  J Neurosurg. 1990;  73 (1) 18-36
• 11 Krayenbuhl H, Yasargil M G. [Use of the surgical microscope in the management of vascular cerebrospinal diseases].  Munch Med Wochenschr. 1968;  110 (35) 1931-1934
• 12 Linn F H, Rinkel G J, Algra A, van Gijn J. Incidence of subarachnoid hemorrhage: role of region, year, and rate of computed tomography: a meta-analysis.  Stroke. 1996;  27 (4) 625-629
• 13 Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial.  Lancet. 2002;  360 (9342) 1267-1274
• 14 Okahara M, Kiyosue H, Yamashita M, Nagatomi H, Hata H, Saginoya T, Sagara Y, Mori H. Diagnostic accuracy of magnetic resonance angiography for cerebral aneurysms in correlation with 3D-digital subtraction angiographic images: a study of 133 aneurysms.  Stroke. 2002;  33 (7) 1803-1808
• 15 Raaymakers T W, Rinkel G J, Limburg M, Algra A. Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis.  Stroke. 1998;  29 (8) 1531-1538
• 16 Rinkel G J, van Gijn J, Wijdicks E F. Subarachnoid hemorrhage without detectable aneurysm. A review of the causes.  Stroke. 1993;  24 (9) 403-1409
• 17 Sidman R, Connolly E, Lemke T. Subarachnoid hemorrhage diagnosis: lumbar puncture is still needed when the computed tomography scan is normal.  Acad Emerg Med. 1996;  3 (9) 827-831
• 18 Sugahara T, Korogi Y, Nakashima K, Hamatake S, Honda S, Takahashi M. Comparison of 2D and 3D digital subtraction angiography in evaluation of intracranial aneurysms.  Am J Neuroradiol. 2002;  23 (9) 1545-1552
• 19 Thornton J, Bashir Q, Aletich V A, Debrun G M, Ausman J I, Charbel F T. What percentage of surgically clipped intracranial aneurysms have residual necks?.  Neurosurgery. 2000;  46 (6) 1294-1298 ,  discussion 1298 - 1300
• 20 van Gijn J, van Dongen K J. The time course of aneurysmal haemorrhage on computed tomograms.  Neuroradiology. 1982;  23 (3) 153-156
• 21 Wiesmann M, Mayer T E, Yousry I, Medele R, Hamann G F, Bruckmann H. Detection of hyperacute subarachnoid hemorrhage of the brain by using magnetic resonance imaging.  J Neurosurg. 2002;  96 (4) 684-689
• 22 Yalamanchili K, Rosenwasser R H, Thomas J E, Liebman K, McMorrow C, Gannon P. Frequency of cerebral vasospasm in patients treated with endovascular occlusion of intracranial aneurysms.  Am J Neuroradiol. 1998;  19 (3) 553-558

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