Brain Haemorrhage / Strokes / Aneurysms.
Most strokes are managed by neurologists but neurosurgeons are involved with subarachnoid haemorrhage and intracerebral haemorrhages. This is an area with many unanswered questions but also excellent examples of the benefits of clinical research. The most common cause of subarachnoid haemorrhage is an aneurysm. Clipping an aneurysm is a technically difficult operation that has been dramatically improved by advances in neuroanaesthesia, neuroimaging and the use of the operating microscope.
Many aneurysms are now being treated without surgery by placing coils into them through a catheter inserted through an artery in the leg. This is changing the whole concept of management of a patient with subarachnoid haemorrhage.
Another benefit of epidemiological research is the vast amount of information that is available regarding the natural history of these aneurysms. This is vital in deciding which aneurysms to clip and when to do so. Modern imaging is now detecting aneurysms before they have ruptured and this leads to the difficult decision about undertaking a potentially high-risk operation or living with the risk of rupture of the aneurysm. It is impossible to compare the choice unless information is available on the risks and benefits of them. Some patients who have a subarachnoid haemorrhage may die or have a stroke because the arteries go into spasm. This has been known about for a long time but the causes and treatment are still being defined. Large international trials of drugs aimed at reducing this complication are under-way, costing many millions of dollars. We have been involved in some of these are currently part of a trial of these drugs in subarachnoid haemorrhage due to trauma.
PO Box 698, North Adelaide SA 5006, Australia
Telephone: +61 8 8371 0771
nrfginta@bigpond.com
