Surgical Treatment Of Intracranial Aneurysm

Objective In order to promoting the understanding and showing light on the clinical diagnosis and treatment of aneurysm. A series of 1040 patients with spontaneous subarachnoid hemorrhage (SAH) and intracranial aneurysm were analyzed retrospectively.Methods The data of 1040 cases, which 1025 were spontaneous SAH patients and 15 were intracranial aneurysm patients without hemorrhage of the Huanhu hospital between January 2000 and December 2003 were analysized. Surgical clipping or interventional embolization were performed in 490 patients which were especially investigated.Results 124 (65.96%) of 188 patients with rebleeding in the group were worsening from the untreated aneurysm being Grade IV-V even to die. 705 patients were examined by digital subtraction angiography (DSA), including 13 cases with aneurysm had been proved by MRA. 647 aneurysms were founded in 542 cases, but 19 cases were explored during the operation of eliminating intracranial hematoma. The prognosis of treatment was classified according to Glasgow Outcome Scale (GOS). 141 cases were excellent after operation, but poor outcomes in 44 according to the different Hunt&Hess grade. The outcomes in endovascular coiling groups were 255 and 50. The good prognosis of the elderly patients (> or = 65 years) in both surgical clipping group and endovascular coiling group were 19 and 33 respectively, the poor were 7 and 15, respectively. For the anterior circulation aneurysms, favorable and unfavorable outcomes in both groups were 122 & 192 and 32 & 38, respectively. 13 of 154 patients with aneurysms reruprured during operation, 15 of 230 reruptured during endovascular embolization.Conclusions As the primary cause of spontaneous SAH is ruptured aneurysm, which is associated with high morbidity and mortality from second haemorrhage. Patients with better clinical grades (under Grades III) when hospitalized would receive good prognosis, no matter which treatment were performed. Patients of poor grades (Grade IV-V) after aneurysmal SAH often received a bad outcome, but about 17 percent patients achieved favorable outcomes in surgical clipping group, 25 percent patients in endovascular coiling group. So early aggressive treatment should be performed. When it comes to the overall outcome of elderly and the anterior circulation aneurysms patients, no significant difference was found between the two treatment groups. No evidence was found that pre-operative or pre-embolization continuous ventricular or lumbar CSF drainage was associated with an increased risk of aneurysm rebleeding. The optimal period of surgical clipping was more than 15 days post SAH, and...