The Research Of Surgical Timing For Ruptured Intracranial Aneurysms: Analysis Of 535 Cases

Objective: studying on the timing of intracranial aneurysms with different location and grade.Method: the data from 535 cases of ruptured intracranial aneurysms surgery identified in our hospital from Jan .2005 to Dec. 2010 was retrospectively analysed . All the patients were divided into P group(posterior communicating artery aneurysms n=216) ,A group(anterior communicating artery aneurysms n=212) and M group (middle cerebral artery aneurysms n=107). According Hunt and hurt grade , every group was divided into grade 1-2, grade3 ,grade4-5. all the patients received microsurgical treatment via pterion approach or improved pterion approach to clip the aneurysm. Early aneurysm surgery was defined as operation performed within three days after onset of aneurismal hemorrhage , intermediate aneurysm surgery as performed on days four to fourteen , late aneurysm surgery as performed after day fourteen .the GOS of patients when they got out of hospital and the incidence of the complications were compared by Chi-square .Results: in P group according GOS,32 cases of early aneurysm surgery were in good clinical condition , 9 cases in poor outcome,7casas in death or predying state ,cerebral infarction caused by cerebral vasospasm occurred in 15 cases, 2 cases got hydrocephalus. 68 cases of intermediate aneurysm surgery were in good clinical condition , 24 cases in poor outcome , 7cases in death or predying state ,cerebral infarction caused by cerebral vasospasm occurred in 50 cases, 1 cases got hydrocephalus. 57 cases of late surgery were in good clinical condition , 9 cases in poor outcome , 3 cases in death or predying state ,cerebral infarction caused by cerebral vasospasm occurred in 40cases . In A group , 64 cases of early aneurysm surgery were in good clinical condition , 11 cases in poor outcome , 9 cases in death or predying state , cerebral infarction caused by cerebral vasospasm occurred in 41 cases , 2 cases got hydrocephalus. 67 cases of intermediate aneurysm surgery were in good clinical condition , 9 cases in poor outcome , 7 cases in death or predying state , cerebral infarction caused by cerebral vasospasm occurred in 35 cases , 5 cases got hydrocephalus. 34 of late surgery were in good clinical condition, 10 cases in poor outcome , 0 cases in death or predying state , cerebral infarction caused by cerebral vasospasm occurred in 25 cases , 8 cases got hydrocephalus. In group M 20 cases of early aneurysm surgery were in good clinical condition , 15 cases in poor outcome, 6 cases in death or predying state ,cerebral infarction caused by cerebral vasospasm occurred in 14 cases , cases,1 cases got hydrocephalus. 23 cases of intermediate aneurysm surgery were in good clinical condition , 8 cases in poor outcome, 5 cases in death or predying state , cerebral infarction caused by cerebral vasospasm occurred in 15 cases , 0 cases got hydrocephalus. 19 cases of late surgery were in good clinical condition ,8 cases in poor outcome , 2 cases in death or predying state . cerebral infarction caused by cerebral vasospasm occurred in 9 cases , 3 cases got hydrocephalus. After compared by Chi-square,in group P the patients in Hunt and Hess Grade-4, the cases treated by late surgery faced a higher the incidence of hydrocephalus than the cases treated by early and intermediate surgery did , Chi-square 6.155 ,P 0.046(P<0.05). the cases treated by early surgery were better than the cases treated by intermediate and late surgery for incidence of cerebral infarction caused by cerebral vasospasm , Chi-square 6.572 ,P 0.014(P<0.05) ,In group A for the patients in Hunt and Hess Grade1-2 and4-5, the cases treated by early surgery received a smaller the incidence of hydrocephalus than the cases treated by late and intermediate surgery did , Chi-square 8.255 ,P 0.016(P<0.05) and, Chi-square 7.455 ,P 0.024(P<0.05) . In group M Hunt and Hess Grade4-5, the cases treated by early surgery were better than the cases treated by intermediate and late surgery for incidence of cerebral infarction caused by cerebral vasospasm , Chi-square 6.091 ,P 0.048(P<0.05) ,Conclusion: All three groups , the patients in Hunt and hurt grade 1-3 should receive early aneurysm surgery , For patients in Hunt and hurt grade 4-5, no matter that whether patients had the disease histories of diabetes or hypertension, this trial proposal early aneurysm surgery for all cases, in which the aneurysms were clipped early .Early surgery could prevented the aneurysms rebleeding in order to avoid cerebral vasospasm and complications of aneurismal subarachnoid hemorrhage.