Neurosurgical Procedures Versus Endovascular Treatment For Interventions Of Intracranial Aneurysms: An Analysis Of The Prognosis And The Related Factors To It (Report Of 856 Cases)

Objective: To study the prognosis and the related factors to it of neurosurgical procedures or endovascular treatment in patients with intracranial aneurysms.Methods: Eight hundred and fifty-six patients with intracranial aneurysms were reviewed between January 2003 and September 2007. Except for the data of 17 for various reasons,the other 839 patients with intracranial aneurysms were treated with neurosurgical procedures or endovascular treatment. 722 patients were treated with neurosurgical procedures, including 702 patients with surgical clipping with the neck of the aneurysms, 7 with trapping of the aneurysms, and 13 with ligation of the carotid. 117 patients were treated with endovascular interventions, including 101 embolization, 7 embolization with stent, 8 with only stenting technique, and only one with balloon technique. The postoperative complications, length of hospitalization and MRS score at discharge in patients with the two interventions were compared. Discuss the relationship between prognosis and age, hypertension, Hunt-Hess Scale, Fisher Scale. The results was analysed by SPSS (version 14.0). A 2-tailed probability value of <0.05 was considered to be statistically significant.Results: The good outcomes (MRS score 0~2) in the groups of endovascular treatment and neurosurgical procedures were 92.31% and 81.86%, respectively; the poor outcomes (MRS score 3~6) were 7.79% and 18.14%, respectively; and their mortalities (MRS score 6) were 2.56% and 4.29% (P=0.379).No matter what the endovascular treatment or the neurosurgical procedures, there is no significance in poor prognosis between the early operation (≤3days) and the later operation (≥14days). The results of pearson chi-square show that prognosis is associated with age, hypertension, preoperative Hunt-Hess Scale and Fisher Scale. Further analysis with Logisitic regression shows that hypertension, preoperative Hunt-Hess Scale and Fisher Scale without age are the independent risk factors.The difference of length of hospitalization between the two interventions is statistically significant. And also is the postoperative neurological complications.Conclusion: For the nonrandomized patients with intracranial aneurysms, the prognosis of endovascular treatment may be superior to the prognosis of neurosurgical procedures. There is poor prognosis for the patients of hypertension, higher preoperative Hunt-Hess and Fisher Scale no matter how the patients are treated. The time of hospitalization of patients who accept the endovascular treatment is shorter than that of the patients who accept neurosurgical procedures. The correlation between operation time and prognosis need further discussion.