Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Review article: Biomedical intelligence

Vol. 144 No. 1718 (2014)

Management of aneurysmal subarachnoid haemorrhage

  • Bawarjan Schatlo
  • Ali-Reza Fathi
  • Javier Fandino
DOI
https://doi.org/10.4414/smw.2014.13934
Cite this as:
Swiss Med Wkly. 2014;144:w13934
Published
20.04.2014

Summary

Aneurysmal subarachnoid haemorrhage (aSAH) occurs as a result of rupture of an intracranial aneurysm and affects a younger population compared with ischaemic stroke or intracerebral haemorrhage. Although it makes up only about 5% of all cerebrovascular events, it accounts for over a quarter of the productive life-years lost to stroke. Its surgical and medical treatment represents a multidisciplinary effort. We herein provide an overview of current management options for aSAH.

References

  1. de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry[Review]. 2007;78(12):1365–72.
  2. Johnston SC, Selvin S, Gress DR. The burden, trends, and demographics of mortality from subarachnoid hemorrhage. Neurology. 1998;50(5):1413–8.
  3. Taylor CL, Yuan Z, Selman WR, Ratcheson RA, Rimm AA. Mortality rates, hospital length of stay, and the cost of treating subarachnoid hemorrhage in older patients: institutional and geographical differences. J Neurosurg. 1997;86(4):583–8.
  4. Dodel R, Winter Y, Ringel F, Spottke A, Gharevi N, Muller I, et al. Cost of illness in subarachnoid hemorrhage: a German longitudinal study. Stroke. 2010;41(12):2918–23.
  5. Meyer B, Ringel F, Winter Y, Spottke A, Gharevi N, Dams J, et al. Health-related quality of life in patients with subarachnoid haemorrhage. Cerebrovasc dis.[Comparative Study]. 2010;30(4):423–31.
  6. Macdonald RL, Pluta RM, Zhang JH. Cerebral vasospasm after subarachnoid hemorrhage: the emerging revolution. Nat Clin Pract Neurol. 2007;3(5):256–63.
  7. Connolly ES, Jr., Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke[Practice Guideline]. 2012;43(6):1711–37.
  8. Jakobsson KE, Saveland H, Hillman J, Edner G, Zygmunt S, Brandt L, et al. Warning leak and management outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg. 1996;85(6):995–9.
  9. van der Wee N, Rinkel GJ, Hasan D, van Gijn J. Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? J Neurol Neurosurg Psychiatry. 1995;58(3):357–9.
  10. Adams HP, Jr., Kassell NF, Torner JC, Sahs AL. CT and clinical correlations in recent aneurysmal subarachnoid hemorrhage: a preliminary report of the Cooperative Aneurysm Study. Neurology. 1983;33(8):981–8.
  11. Mitchell P, Wilkinson ID, Hoggard N, Paley MN, Jellinek DA, Powell T, et al. Detection of subarachnoid haemorrhage with magnetic resonance imaging. J Neurol Neurosurg Psychiatry. 2001;70(2):205–11.
  12. Edlow JA, Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med. [Review]. 2000;342(1):29–36.
  13. Page KB, Howell SJ, Smith CM, Dabbs DJ, Malia RG, Porter NR, et al. Bilirubin, ferritin, D-dimers and erythrophages in the cerebrospinal fluid of patients with suspected subarachnoid haemorrhage but negative computed tomography scans. J Clin Pathol. 1994;47(11):986–9.
  14. Petzold A, Worthington V, Appleby I, Kerr ME, Kitchen N, Smith M. Cerebrospinal fluid ferritin level, a sensitive diagnostic test in late-presenting subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2011;20(6):489–93.
  15. Roitberg BZ, Hardman J, Urbaniak K, Merchant A, Mangubat EZ, Alaraj A, et al. Prospective randomized comparison of safety and efficacy of nicardipine and nitroprusside drip for control of hypertension in the neurosurgical intensive care unit. Neurosurgery. 2008;63(1):115–20; discussion 20–1.
  16. Liu-Deryke X, Janisse J, Coplin WM, Parker D, Jr., Norris G, Rhoney DH. A comparison of nicardipine and labetalol for acute hypertension management following stroke. Neurocrit Care. [Comparative Study]. 2008;9(2):167–76.
  17. Olkowski BF, Devine MA, Slotnick LE, Veznedaroglu E, Liebman KM, Arcaro ML, et al. Safety and Feasibility of an Early Mobilization Program for Patients With Aneurysmal Subarachnoid Hemorrhage. Phys Ther. 2012;20.
  18. Wurm G, Tomancok B, Nussbaumer K, Adelwohrer C, Holl K. Reduction of ischemic sequelae following spontaneous subarachnoid hemorrhage: a double-blind, randomized comparison of enoxaparin versus placebo. Clin Neurol Neurosurg. 2004;106(2):97–103.
  19. Siironen J, Juvela S, Varis J, Porras M, Poussa K, Ilveskero S, et al. No effect of enoxaparin on outcome of aneurysmal subarachnoid hemorrhage: a randomized, double-blind, placebo-controlled clinical trial. J Neurosurg. 2003;99(6):953–9.
  20. Juvela S, Siironen J, Varis J, Poussa K, Porras M. Risk factors for ischemic lesions following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2005;102(2):194–201.
  21. Collaboration CT, Dennis M, Sandercock PA, Reid J, Graham C, Murray G, et al. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet. 2009;373(9679):1958–65.
  22. Qureshi AI, Suri MF, Sung GY, Straw RN, Yahia AM, Saad M, et al. Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurgery. 2002;50(4):749–55; discussion 55–6.
  23. Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability and risk factors for aneurysm rupture. Neurosurg Focus. 2000;8(5):Preview 1.
  24. Hagmann P, Jonasson L, Maeder P, Thiran JP, Wedeen VJ, Meuli R. Understanding diffusion MR imaging techniques: from scalar diffusion-weighted imaging to diffusion tensor imaging and beyond. Radiographics. 2006;26 Suppl1:S205–23.
  25. Connolly ES, Jr., Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43(6):1711–37.
  26. Dankbaar JW, Slooter AJ, Rinkel GJ, Schaaf IC. Effect of different components of triple-H therapy on cerebral perfusion in patients with aneurysmal subarachnoid haemorrhage: a systematic review. Crit care. 2010;14(1):R23.
  27. Rosengart AJ, Huo JD, Tolentino J, Novakovic RL, Frank JI, Goldenberg FD, et al. Outcome in patients with subarachnoid hemorrhage treated with antiepileptic drugs. J Neurosurg. [Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't]. 2007;107(2):253–60.
  28. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al. 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):1267–74.
  29. Raja PV, Huang J, Germanwala AV, Gailloud P, Murphy KP, Tamargo RJ. Microsurgical clipping and endovascular coiling of intracranial aneurysms: a critical review of the literature. Neurosurgery. 2008;62(6):1187–202; discussion 202–3.
  30. Molyneux AJ, Kerr RS, Birks J, Ramzi N, Yarnold J, Sneade M, et al. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol. 2009;8(5):427–33.
  31. Spetzler RF, McDougall CG, Albuquerque FC, Zabramski JM, Hills NK, Partovi S, et al. The Barrow Ruptured Aneurysm Trial: 3–year results. J Neurosurg. 2013;119(1):146–57.
  32. Koivisto T, Vanninen R, Hurskainen H, Saari T, Hernesniemi J, Vapalahti M. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study. Stroke. 2000;31(10):2369–77.
  33. Qian W, Chan Q, Mak H, Zhang Z, Anthony MP, Yau KK, et al. Quantitative assessment of the cervical spinal cord damage in neuromyelitis optica using diffusion tensor imaging at 3 Tesla. J Magn Reson Imaging. 2011;33(6):1312–20.
  34. Marbacher S, Tomasi O, Fandino J. Management of Patients Presenting with Acute Subdural Hematoma due to Ruptured Intracranial Aneurysm. Int J Vasc Med. 2012;2012:753596.
  35. Fandino J, Taussky P, Marbacher S, Muroi C, Diepers M, Fathi AR, et al. The concept of a hybrid operating room: applications in cerebrovascular surgery. Acta Neurochir Suppl. 2013;115:113–7.
  36. Schaller K, Kotowski M, Pereira V, Rufenacht D, Bijlenga P. From intraoperative angiography to advanced intraoperative imaging: the geneva experience. Acta Neurochir Suppl. [Research Support, Non-U.S. Gov't]. 2011;109:111–5.
  37. Neuloh G, Schramm J. Monitoring of motor evoked potentials compared with somatosensory evoked potentials and microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurosurg. 2004;100(3):389–99.
  38. Raabe A, Beck J, Seifert V. Technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using surgical microscope integrated near-infrared video technology. Zentralbl Neurochir. 2005;66(1):1–6; discussion 7–8.
  39. Langer DJ, Van Der Zwan A, Vajkoczy P, Kivipelto L, Van Doormaal TP, Tulleken CA. Excimer laser-assisted nonocclusive anastomosis. An emerging technology for use in the creation of intracranial-intracranial and extracranial-intracranial cerebral bypass. Neurosurg Focus. 2008;24(2):E6.
  40. Bednarik J, Sladkova D, Kadanka Z, Dusek L, Kerkovsky M, Vohanka S, et al. Are subjects with spondylotic cervical cord encroachment at increased risk of cervical spinal cord injury after minor trauma? J Neurol Neurosurg Psychiatry. 2011;82(7):779–81.
  41. Kulcsar Z, Wetzel SG, Augsburger L, Gruber A, Wanke I, Rufenacht DA. Effect of flow diversion treatment on very small ruptured aneurysms. Neurosurgery. 2010;67(3):789–93.
  42. Wang CM, Baer DR, Thomas LE, Amonette JE, Thevuthasan S, Anthony J, et al. Microstructure of core-shell structured iron-iron oxide nanoparticles. Microsc Microanal. 2005;11 Suppl 2:1994–5.
  43. Kaku Y, Yamashita K, Kokuzawa J, Hatsuda N, Andoh T. Treatment of ruptured cerebral aneurysms – clip and coil, not clip versus coil. Acta Neurochir Suppl. 2010;107:9–13.
  44. Parkinson RJ, Bendok BR, Getch CC, Yashar P, Shaibani A, Ankenbrandt W, et al. Retrograde suction decompression of giant paraclinoid aneurysms using a No. 7 French balloon-containing guide catheter. Technical note. J Neurosurg. 2006;105(3):479–81.
  45. Wostrack M, Sandow N, Vajkoczy P, Schatlo B, Bijlenga P, Schaller K, et al. Subarachnoid haemorrhage WFNS grade V: is maximal treatment worthwhile? Acta Neurochir (Wien). 2013;155(4):579–86.
  46. Graff-Radford NR, Torner J, Adams HP, Jr., Kassell NF. Factors associated with hydrocephalus after subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study. Arch Neurol. 1989;46(7):744–52.
  47. Findlay JM, Kassell NF, Weir BK, Haley EC, Jr., Kongable G, Germanson T, et al. A randomized trial of intraoperative, intracisternal tissue plasminogen activator for the prevention of vasospasm. Neurosurgery. 1995;37(1):168–76; discussion 77–8.
  48. Klopfenstein JD, Kim LJ, Feiz-Erfan I, Hott JS, Goslar P, Zabramski JM, et al. Comparison of rapid and gradual weaning from external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage: a prospective randomized trial. J Neurosurg. 2004;100(2):225–9.
  49. Rabinstein AA, Weigand S, Atkinson JL, Wijdicks EF. Patterns of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke. 2005;36(5):992–7.
  50. Jaeger M, Soehle M, Schuhmann MU, Winkler D, Meixensberger J. Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen. Acta Neurochir (Wien). 2005;147(1):51–6; discussion 6.
  51. Vajkoczy P, Horn P, Thome C, Munch E, Schmiedek P. Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2003;98(6):1227–34.
  52. Sarrafzadeh AS, Kiening KL, Unterberg AW. Neuromonitoring: brain oxygenation and microdialysis. Curr Neurol Neurosci Rep. 2003;3(6):517–23.
  53. Sarrafzadeh AS, Sakowitz OW, Kiening KL, Benndorf G, Lanksch WR, Unterberg AW. Bedside microdialysis: a tool to monitor cerebral metabolism in subarachnoid hemorrhage patients? Crit Care Med. 2002;30(5):1062–70.
  54. Fernandez A, Schmidt JM, Claassen J, Pavlicova M, Huddleston D, Kreiter KT, et al. Fever after subarachnoid hemorrhage: risk factors and impact on outcome. Neurology. 2007;68(13):1013–9.
  55. Badjatia N, Fernandez L, Schmidt JM, Lee K, Claassen J, Connolly ES, et al. Impact of induced normothermia on outcome after subarachnoid hemorrhage: a case-control study. Neurosurgery. 2010;66(4):696–700; discussion -1.
  56. Rossi S, Zanier ER, Mauri I, Columbo A, Stocchetti N. Brain temperature, body core temperature, and intracranial pressure in acute cerebral damage. J Neurol Neurosurg Psychiatry. 2001;71(4):448–54.
  57. Otawara Y, Ogasawara K, Kubo Y, Tomitsuka N, Ogawa A, Suzuki M. Brain and systemic temperature in patients with severe subarachnoid hemorrhage. Surg Neurol. 2003;60(2):159–64; discussion 64.
  58. Springborg JB, Frederiksen HJ, Eskesen V, Olsen NV. Trends in monitoring patients with aneurysmal subarachnoid haemorrhage. Br J Anaesth. 2005;94(3):259–70.
  59. Budohoski KP, Czosnyka M, Kirkpatrick PJ, Smielewski P, Steiner LA, Pickard JD. Clinical relevance of cerebral autoregulation following subarachnoid haemorrhage. Nature Rev Neurol. 2013;9(3):152–63.
  60. Budohoski KP, Czosnyka M, Smielewski P, Varsos GV, Kasprowicz M, Brady KM, et al. Cerebral autoregulation after subarachnoid hemorrhage: comparison of three methods. J Cereb Blood Flow Metab. 2013;33(3):449–56.
  61. Bijlenga P, Czosnyka M, Budohoski KP, Soehle M, Pickard JD, Kirkpatrick PJ, et al. "Optimal cerebral perfusion pressure" in poor grade patients after subarachnoid hemorrhage. Neurocrit Care. 2010;13(1):17–23.
  62. Frontera JA, Rundek T, Schmidt JM, Claassen J, Parra A, Wartenberg KE, et al. Cerebrovascular reactivity and vasospasm after subarachnoid hemorrhage: a pilot study. Neurology. 2006;66(5):727–9.
  63. Budohoski KP, Czosnyka M, Smielewski P, Kasprowicz M, Helmy A, Bulters D, et al. Impairment of cerebral autoregulation predicts delayed cerebral ischemia after subarachnoid hemorrhage: a prospective observational study. Stroke. 2012;43(12):3230–7.
  64. Enblad P, Persson L. Impact on clinical outcome of secondary brain insults during the neurointensive care of patients with subarachnoid haemorrhage: a pilot study. J Neurol Neurosurg Psychiatry. 1997;62(5):512–6.
  65. Kett-White R, Hutchinson PJ, Al-Rawi PG, Gupta AK, Pickard JD, Kirkpatrick PJ. Adverse cerebral events detected after subarachnoid hemorrhage using brain oxygen and microdialysis probes. Neurosurgery. 2002;50(6):1213–21; discussion 21–2.
  66. Hoffman WE, Wheeler P, Edelman G, Charbel FT, Torres NJ, Ausman JI. Hypoxic brain tissue following subarachnoid hemorrhage. Anesthesiology. 2000;92(2):442–6.
  67. Wolf S, Vajkoczy P, Dengler J, Schurer L, Horn P. Drift of the Bowman Hemedex(R) cerebral blood flow monitor between calibration cycles. Acta Neurochir Suppl. 2012;114:187–90.
  68. Keller E, Nadler A, Niederer P, Yonekawa Y, Imhof HG. A new subdural probe for combined intracranial pressure (ICP) and cerebral blood flow (CBF) monitoring. Acta Neurochir (Wien). 2003;145(12):1111–5; discussion 5.
  69. Dreier JP. The role of spreading depression, spreading depolarization and spreading ischemia in neurological disease. Nature Med. [Research Support, Non-U.S. Gov't Review]. 2011;17(4):439–47.
  70. Hemphill JC, Andrews P, De Georgia M. Multimodal monitoring and neurocritical care bioinformatics. Nature Rev Neurol. 2011;7(8):451–60.
  71. Macdonald RL, Higashida RT, Keller E, Mayer SA, Molyneux A, Raabe A, et al. Clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid haemorrhage undergoing surgical clipping: a randomised, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2). Lancet Neurol. [Clinical Trial, Phase III Randomized Controlled Trial Research Support, Non-U.S. Gov't]. 2011;10(7):618–25.
  72. Dorhout Mees SM, Rinkel GJ, Feigin VL, Algra A, van den Bergh WM, Vermeulen M, et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2007(3):CD000277.
  73. Vergouwen MD, de Haan RJ, Vermeulen M, Roos YB. Effect of statin treatment on vasospasm, delayed cerebral ischemia, and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis update. Stroke. 2010;41(1):e47–52.
  74. Tseng MY, Participants in the International Multidisciplinary Consensus Conference on the Critical Care Management of Subarachnoid H. Summary of evidence on immediate statins therapy following aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2011;15(2):298–301.
  75. Nicholls SJ, Ballantyne CM, Barter PJ, Chapman MJ, Erbel RM, Libby P, et al. Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med. 2011;365(22):2078–87.
  76. van den Bergh WM, Algra A, van der Sprenkel JW, Tulleken CA, Rinkel GJ. Hypomagnesemia after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2003;52(2):276–81; discussion 81–2.
  77. Suarez JI, Participants in the International Multidisciplinary Consensus Conference on the Critical Care Management of Subarachnoid H. Magnesium sulfate administration in subarachnoid hemorrhage. Neurocrit Care. 2011;15(2):302–7.
  78. Wong GK, Poon WS, Chan MT, Boet R, Gin T, Ng SC, et al. Intravenous magnesium sulphate for aneurysmal subarachnoid hemorrhage (IMASH): a randomized, double-blinded, placebo-controlled, multicenter phase III trial. Stroke. 2010;41(5):921–6.
  79. Muroi C, Terzic A, Fortunati M, Yonekawa Y, Keller E. Magnesium sulfate in the management of patients with aneurysmal subarachnoid hemorrhage: a randomized, placebo-controlled, dose-adapted trial. Surg Neurol. 2008;69(1):33–9; discussion 9.
  80. Barth M, Capelle HH, Weidauer S, Weiss C, Munch E, Thome C, et al. Effect of nicardipine prolonged-release implants on cerebral vasospasm and clinical outcome after severe aneurysmal subarachnoid hemorrhage: a prospective, randomized, double-blind phase IIa study. Stroke. 2007;38(2):330–6.
  81. Abruzzo T, Moran C, Blackham KA, Eskey CJ, Lev R, Meyers P, et al. Invasive interventional management of post-hemorrhagic cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. J Neurointerv Surg. 2012;4(3):169–77.
  82. Zwienenberg-Lee M, Hartman J, Rudisill N, Madden LK, Smith K, Eskridge J, et al. Effect of prophylactic transluminal balloon angioplasty on cerebral vasospasm and outcome in patients with Fisher grade III subarachnoid hemorrhage: results of a phase II multicenter, randomized, clinical trial. Stroke. [Clinical Trial, Phase II Multicenter Study. Randomized Controlled Trial]. 2008;39(6):1759–65.
  83. Solenski NJ, Haley EC, Jr., Kassell NF, Kongable G, Germanson T, Truskowski L, et al. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med. 1995;23(6):1007–17.
  84. Parekh N, Venkatesh B, Cross D, Leditschke A, Atherton J, Miles W, et al. Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage. J Am Coll Cardiol. [Comparative Study Research Support, Non-U.S. Gov't]. 2000;36(4):1328–35.
  85. van der Bilt IA, Hasan D, Vandertop WP, Wilde AA, Algra A, Visser FC, et al. Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage: a meta-analysis. Neurology. 2009;72(7):635–42.
  86. Friedman JA, Pichelmann MA, Piepgras DG, McIver JI, Toussaint LG, 3rd, McClelland RL, et al. Pulmonary complications of aneurysmal subarachnoid hemorrhage. Neurosurgery. 2003;52(5):1025–31; discussion. 31–2.
  87. Stienen MN, Weisshaupt R, Fandino J, Fung C, Keller E, Hildebrandt G, et al. Current practice in neuropsychological outcome reporting after aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien). 2013;155(11):2045–51.
  88. Regli L, Uske A, de Tribolet N. Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series. J Neurosurg. 1999;90(6):1025–30.
  89. Pereira VM, Bijlenga P, Marcos A, Schaller K, Lovblad KO. Diagnostic approach to cerebral aneurysms. Eur J Radiol. 2012;14.
  90. Tomandl BF, Kostner NC, Schempershofe M, Huk WJ, Strauss C, Anker L, et al. CT angiography of intracranial aneurysms: a focus on postprocessing. Radiographics. 2004;24(3):637–55.
  91. Iavindrasana J, Lo Iacono L, Muller H, Periz I, Summers P, Wright J, et al. The @neurIST project. Stud Health Technol Inform. 2008;138:161–4.

Most read articles by the same author(s)