Outcome Analysis In The Intracranial Aneurysm Surgery: A Multifactor Study

Objective: To investigate the impact factors on prognosis of intracranial aneurysm surgery and improve the prognosis of patients with intracranial aneurysms.Methods: We retrospectively reviewed data of 220 intracranial aneurysm inpatients who received clipping surgery in Sichuan Provincial People's hospital from July 2005 to July 2008. Multiple variables including 17 variables divided into 66 dummy variable were analysized by means of the univariable and multi variable logistic regression analysis model SPSS13.0 .The following factors were evaluated: the age and gender of patient, clot thickness of spontaneous subarachnoid hemorrhage (SAH), timing of operation, Hunt-Hess grade, Fisher grade, character of aneurysms, intraoperative conditions and postoperative complications associated with medical diseases.Results: There were 256 intracranial aneurysms in 220 patients, 253 aneurysms were clipped, in which 239 aneurysms in anterior circulation, 14 in posterior circulation. The overall outcome is mortality 5.45%(12cases),mild morbidity 9%(20cases), severely morbidity 8.18% (18cases), vegetable 2.27%(5cases),good 75%(165cases). In the same period, 17 cases died from aneurysms re-rupturing due to waiting for operation. The statistic result showed age, gender, aneurysm size and hydrocephalus preoperative have no significant prognosis value, however CVS, timing of operation, Hunt-Hess grade, Fisher grade, location of aneurysm, operation and medical diseases play a important role in aneurysm prognosis.Conclusion: CVS and rebleeding are the most dangerous factor which leading to mortality and morbidity in aSAH patients, other impact factors include timing of operation, Hunt-Hess grade, Fisher grade, location of aneurysm, operation and medical diseases. Fisher grade can imply DCVS, and predict prognosis indirectly. Hunt-Hess grade is the most reliable prediction factor. The timing of surgery is the key point to improve the prognosis of patients, the selection and decision should be considered severously. Microsurgical techniques are basic demands in aneurysm operation. Prevention and control complications are the fundamental way to improve the prognosis. Age, gender, aneurysm size, preoperative hydrocephalus are not independent risk factors in aneurysm prognosis.