The Close And Long-term Effect After Microsurgery Treatment Of Intracranial Aneurysms Follow-up Analysis Of 140 Cases

Objective:To assess the effect and complications of surgical treatment for intracranial aneurysm and analyze of factors affecting prognosis.Methods:140 intracranial aneurysms patients were treated by microscopic neurosurgry operation during 2000 to 2007,performed by Pro.Xianrui Yuan in Xiangya Hospital,CSU.The patients' symptoms, signs,Kamofsky scales,episodes of rebleeding were followed up to assess the effect of surgical treatment.Multi variable logistic regression was use to analysis the related factors affecting prognosis.Results:All of 161 intracranial aneurysms in 140 patients had been treated by microscopic neurosurgry operation.156 aneurysms of all had been surgically clipping.2.9%of all patients died and 95.0%of them had good outcomes(Kamofsky scale≥60)when been discharged from hospital,1.4%died for rebleeding.No other patient died at mid/long-term follow-up and about 99.3%of all had good outcomes.Hunt-Hess grade before operations was the related factors affecting prognosis in Logistical analysis.There were 15,1,63,30,27 and 4 patients in the group of H-H grade 0(unruptured aneurysms),Ⅰ,Ⅱ,Ⅲ,ⅣandⅤ.the excellent/good rate were 100.0%,100.0%,100.0%,93.3%(28/30),85.2%(23/27) and 75.0%(1/4).There were 10 giant aneurysm(D≥25mm)patients,with the excellent/good rate 90.0%(1/10)and death rate for 10%(1/10), prognosis of the giant aneurysm group was worse than the middle/small group(P＜0.005)in x~2 test.There were 4 patients died in perioperative,2 for aneurysms rebleeding,1 for delayed ischemic deficits and 1 for multiple organ dysfunction syndrome(MODS).1 in 9 patients which aneurysms ruptured during operations died and 8 had excellent/good outcomes.And no statistical difference to the group of safety clipping in x~2 test(P＞0.1).75 disable patients before operation recovered apparently in 6 months after operation and couldn't became better in the following months.125 patients onset for subarachnoid hemorrhage(SAH), 15(12.0%)of them operated in 3 days,16(12.8%)of them operated between 4 to 14 days after SAH and 94(75.2%)of all operated after 14 days,the choice of operation rimming had no relationship to the prognosis by Logistic analysis(P=0.077).Were the CT Fisher grades before operations affected the prognosis depended on the further research(P=0.050).Conclusion:Microscopic neurosurgry operation was an effective method to treat intracranial aneurysms.Prognosis of aneurysms patients depend on the Hunt-Hess grade before operations and the good skilled operators.The important factors due to death were rebleeding,cerebral vasospasm(CVS)and multiple organ dysfunction syndrome(MODS).The effective preparation before operation and correct treatment in operation can decrease the affection to prognosis by intra-operative rupture. Prognosis effected by the choice of operating time and CT Fisher grade develop the further research.The most important period for those disable is 6 months after operation.