Analysis Of Some Related Factors Influencing The Surgical Outcome Of Anterior Circulation Aneurysms

Objective To study some related factors influencing the surgical outcome of anterior circulation aneurysms, we hope to reduce these factors which lead to poor outcome and make corresponding surgical treatment based on patient's condition and economic ability, improve the outcome of aneurysmal patients.Methods 1. Retrospective study the clinical data of 112 cases with intracranial anterior circulation aneurysms from January 1,2008 to December 31,2010,112 patients who underwent clipping aneurysm in the 14th neurosurgical department in Tianjin Huanhu Hospital.132 aneurysmal patients underwent craniotomy surgical treatment in three years in our department, we followed up 112 patients with anterior circulation aneurysms for 6-12 months after discharge from hospital and measured surgical outcome by Glasgow Outcome Scale.112 patients could not undergo coiling because of various reasons, so chose clipping treament, two experienced doctors performed operation. We analyzed 12 factors such as:age, hypertension, smoking, characteristics of aneurysms (quantity, location and size), Fisher grade, Hunt-Hess grade, intraoperative ventricular puncture, intraoperative aneurysm rupture, intraoperative parent artery occlusion and the timing of operation, and analyzed the influence of various factors on the outcome by means of univariable analysis and multivariable Logistic regression analysis with SPSS 17.0. Meanwhile, 6 factors which may influence surgical outcome but now can not use statistical analysis were discussed in this dissertation.2.70 patients underwent clipping who could not afford intervention embolism expense because of poor economic condition in 112 patients who were followed up, meanwhile, we retrospective study the clinical data of 60 patients with anterior circulation aneurysms who underwent coiling by the same experienced doctor from group A (two coiling treatment groups in our department:group A and group B) in the same period,60 patients were measured surgical outcome by Glasgow Outcome Scale when they reviewed DSA in 6 months after discharge from hospital. We analyzed clinical outcome and medical costs of two groups of patients by Chi-square test and independent sample T test. Results 1.The univariable analysis reults show as followed:①he short-term prognostic differences of patients with different Fisher grade and different Hunt-Hess grade have statistically significant(P<0.05).②The prognostic differences of patients with different age have no statistically significant(P>0.05).③The prognostic differences of patients with hypertension and patients with normal blood pressure have no statistically significant(P>0.05).④The prognostic differences of smoking patients and non-smoking patients have no statistically significant(P>0.05).④The prognostic differences of patients with different quantity, site and size aneurysms have no statistically significant(P>0.05).⑥The prognostic differences of patients with different operation time have no statistically significant(P>0.05).⑦The prognostic differences of patients with intraoperative ventricular puncture and patients without ventricular puncture have no statistically significant(P>0.05).⑧he prognostic differences of patients with intraoperative aneurysm rupture and patients without intraoperative aneurysm rupture have no statistically significant(P>0.05).⑨The prognostic differences of patients with intraoperative parent artery occlusion and patients without intraoperative parent artery occlusion have no statistically significant(P>0.05). The multivariable Logistic regression analysis results show: Fisher grade and Hunt-Hess grade are independent risk factors influencing the short-term outcome of aneurysmal patient.We analyzed Fisher lst-3rd grade and Fisher 4th grade by multivariable Logistic regression analysis, the finding shows: patients whose Fisher 4th grade poor outcome ratio were 6.874 to Fisher 1st-3rd grade, Then we analyzed Hunt-HessⅠ-Ⅲgrade and Hunt-HessⅣ-Ⅴgrade by multivariable Logistic regression analysis, the finding display:patients whose Hunt-HessⅣ-Ⅴgrade poor outcome ratio were 6.451 to Hunt-HessⅠ-Ⅲgrade.2.The outcome of aneurysmal patients who underment coiling and underment clipping in the same period was analyzed by means of Chi-square test, the reult shows:the prognostic differences of patients with different treatments have no statistically significant(P> 0.05). The medical cost was analyzed by means of independent sample T test, the reult shows:medical cost differences have statistically significant (P<0.05), the cost of clipping was much lower than coiling.Conclusion 1. Fisher grade and Hunt-Hess grade are independent risk factors influencing the short-term outcome. age, hypertension, somking, the aneurysm quantity, the aneurysm site, the aneurysm size, the timing of operation, intraoperative ventricular puncture, intraoperative aneurysm rupture and Intraoperative parent artery occlusion do not influence the short-term outcome.2. Clipping or coiling in the treatment of anterior circulation aneurysms, patients got high favorable outcome ratio, but the cost of clipping was much lower than coiling.