Analysis The Prognostic Factors Of Keyhole Microsurgery For Ruptured Anterior Circulation Aneurysms With Intracranial Hematomas

Objective: To report the outcome of Keyhole Microsurgery for ruptured anterior circulation aneurysms with intracranial hematomas and to study the indications and prognostic factors.Methods: The clinical data of 32 consecutive patients who were diagnosed as Aneurysms associated with hematomas and underwent Keyhole Microsurgery(aneurysms clipping, hematoma evacuation) in First Affiliated Hospital of Fujian Medical University, Neurosurgery, from December 2012 to August 2015, were collected and analyzed. Functional outcome were assessed according to the Modified Rankin Scale at 3 month after ictus. All data were analyzed by SPSS 20.0 software. P<0.05 was considered statistically significant.Results: In the 32 cases, 2 patients underwent decompressive cranioectomy after Keyhole Microsurgery, because of consciousness deteriorated and intracranial pressure increased. The outcome was assessed by follow-up for 6-24 months. According to the Modified Rankin Scale at 3 month after ictus: dead in 3 patients, serious disability in 0, severe disability in 1, moderate disability in 3 cases, 25 cases with good recovery. According to the Modified Rankin Scale at 6 month after ictus: dead in 3 patients, serious disability in 0, severe disability in 1, moderate disability in 1 cases, 27 cases with good recovery. On prognostic analysis, the following variables were associated with better chances of having a good recovery: without disturbance of consciousness(P=0.037), without Oculomotor nerve involvement(P=0.037), better Modified Fisher grade(P=0.038), better PAASH(prognosis on admission of aneurysmal subarachnoid hemorrhage) grade(P=0.004), better Hunt&Hess grade(P=0.023) at any of the times of assessment before operation.Conclusion: 1. The outcome of Keyhole Microsurgery for patients with anterior circulation aneurysms associated with hematomas were satisfied overall; 2. It was suggested that preoperative conditions such as level of consciousness, third cranial nerve involvement, Modified Fisher grade, PAASH grade, Hunt-Hess grade affect the prognosis(P <0.05), but sex,, smoking history, alcohol consumption, hematoma volume, aneurysm size, aneurysm location and so on seem like without exact connection to prognosis;...