Department of Neurology, Heidelberg University, Heidelberg, Germany.
Cerebrovasc Dis. 2013;35(2):93-112. doi: 10.1159/000346087. Epub 2013 Feb 7.
Intracranial aneurysm with and without subarachnoid haemorrhage (SAH) is a relevant health problem: The overall incidence is about 9 per 100,000 with a wide range, in some countries up to 20 per 100,000. Mortality rate with conservative treatment within the first months is 50-60%. About one third of patients left with an untreated aneurysm will die from recurrent bleeding within 6 months after recovering from the first bleeding. The prognosis is further influenced by vasospasm, hydrocephalus, delayed ischaemic deficit and other complications. The aim of these guidelines is to provide comprehensive recommendations on the management of SAH with and without aneurysm as well as on unruptured intracranial aneurysm.
We performed an extensive literature search from 1960 to 2011 using Medline and Embase. Members of the writing group met in person and by teleconferences to discuss recommendations. Search results were graded according to the criteria of the European Federation of Neurological Societies. Members of the Guidelines Committee of the European Stroke Organization reviewed the guidelines.
These guidelines provide evidence-based information on epidemiology, risk factors and prognosis of SAH and recommendations on diagnostic and therapeutic methods of both ruptured and unruptured intracranial aneurysms. Several risk factors of aneurysm growth and rupture have been identified. We provide recommendations on diagnostic work up, monitoring and general management (blood pressure, blood glucose, temperature, thromboprophylaxis, antiepileptic treatment, use of steroids). Specific therapeutic interventions consider timing of procedures, clipping and coiling. Complications such as hydrocephalus, vasospasm and delayed ischaemic deficit were covered. We also thought to add recommendations on SAH without aneurysm and on unruptured aneurysms.
Ruptured intracranial aneurysm with a high rate of subsequent complications is a serious disease needing prompt treatment in centres having high quality of experience of treatment for these patients. These guidelines provide practical, evidence-based advice for the management of patients with intracranial aneurysm with or without rupture. Applying these measures can improve the prognosis of SAH.
颅内动脉瘤伴或不伴蛛网膜下腔出血（SAH）是一个相关的健康问题：总体发病率约为每 10 万人中有 9 例，范围很广，在一些国家高达每 10 万人中有 20 例。在最初几个月内采用保守治疗的死亡率为 50-60%。大约三分之一未经治疗的动脉瘤患者在首次出血恢复后 6 个月内会因再次出血而死亡。血管痉挛、脑积水、迟发性缺血性缺损和其他并发症进一步影响预后。本指南的目的是提供关于伴有和不伴有动脉瘤的 SAH 以及未破裂颅内动脉瘤的综合管理建议。
我们使用 Medline 和 Embase 进行了从 1960 年到 2011 年的广泛文献检索。写作小组成员通过面对面会议和电话会议讨论建议。根据欧洲神经病学学会的标准对搜索结果进行分级。欧洲卒中组织指南委员会的成员审查了指南。
这些指南提供了关于 SAH 的流行病学、危险因素和预后的循证信息，以及关于破裂和未破裂颅内动脉瘤的诊断和治疗方法的建议。已经确定了几个动脉瘤生长和破裂的危险因素。我们提供了关于诊断评估、监测和一般管理（血压、血糖、体温、血栓预防、抗癫痫治疗、使用类固醇）的建议。特定的治疗干预考虑了手术时机、夹闭和血管内治疗。涵盖了脑积水、血管痉挛和迟发性缺血性缺损等并发症。我们还认为应添加关于无动脉瘤性 SAH 和未破裂动脉瘤的建议。
破裂的颅内动脉瘤伴有较高的后续并发症发生率，是一种严重的疾病，需要在有经验治疗这些患者的高质量中心进行及时治疗。这些指南为伴有或不伴有破裂的颅内动脉瘤患者的管理提供了实用的、基于证据的建议。应用这些措施可以改善 SAH 的预后。
