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(Stroke. 1999;30:2759-a.)
© 1999 American Heart Association, Inc.

Letters to the Editor

Treatment for Ruptured Aneurysms and Screening for Unruptured Aneurysms

Yuhei Yoshimoto, MD

Department of Neurosurgery, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan

	Introduction

 
To the Editor:

I read with interest the letter to the editor from Yamashita et al, "Trend in Outcome of Cerebral Aneurysmal Rupture Since 1985: A Proposal for Future Treatment,"¹ and would like to comment on a couple of points.

I think that the population-based study of cerebral aneurysms conducted by Yamashita et al² has greatly contributed to our understanding of the epidemiology of subarachnoid hemorrhage (SAH) and the recent results of treatment. In the letter, 3119 patients with SAH between 1985 and 1997 in Yamaguchi prefecture were enrolled, corresponding to 240 patients annually. All of these patients were admitted to 1 of 28 neurosurgical centers. Thus, the average number of patients treated per institute was only 8.6 per year. I basically agree with the opinion of the authors that, judging from the trend of treatment results over the last 13 years, the outcome of SAH patients will not improve dramatically in the near future. However, I think that it may be possible to improve the outcome by concentrating these 240 patients in 3 or 4 institutes. It has been shown that in many kinds of diseases, treatment results in hospitals managing a larger number of patients are superior to those in hospitals treating a smaller number of patients. Therefore, after initial resuscitation, patients with SAH should be transferred to such institutes, where intensive care, including surgery for aneurysms and management of cerebral vasospasm, should be managed. Because the present situation in Yamaguchi prefecture could also apply to most of . . . [Full Text of this Article]

Katsuhiro Yamashita, MD

Department of Neurosurgery, Onoda City Hospital, Onoda, Yamaguchi, Japan

Shiro Kashiwagi, MD Shoichi Kato, MD

Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan