Prognostic Analysis Of Craniotomy And Interventional Therapy For Anterior Circulation Ruptured Intracranial Aneurysm

OBJECTIVE:This study compared the outcomes of IA patients with anterior circulation ruptured IA whom being treated by craniotomy clipping or endovascular embolization,and provided the basis for selecting which surgical approach should be better to patients with anterior circulation ruptured IA in the clinical work,thereby improving the survival rate and postoperative living quality of patients.METHODS:We retrospectively analyzed the clinical data of 162 patients with anterior circulation ruptured IA in our hospital from January 2011 to December 2016.Among them,32 patients underwent craniotomy clipping and 130 underwent endovascular interventional embolization.The difference of prognosis was judged by comparing the average length of hospital stay,the incidence of complications,the half-year postoperative GOS prognosis score,and the recurrence rate of the two operations.We used univariate analysis to identify the risk factors for poor prognosis of anterior circulation ruptured IA,and then use Logistic Multivariate regression analysis to identify its independent risk factors.RESULTS:The mean length of hospital stay for craniotomy of anterior circulation rupture IA was 44.60 ±7.84,while the average length of hospital stay for interventional embolization was 21.46 ± 1.57.The mean length of hospital stay for endovascular embolization was shorter than that for craniotomy(p=0.00<0.05).The incidence of cerebral vasospasm in the craniotomy group and the intervention group was 50%and 24.62%,respectively,while that of hydrocephalus was 21.88%and 9.23%,and that of rebleeding was 3.13%and 4.62%,respectively.The incidence of rebleeding was not statistically significant(P=0.710>0.05),but the incidence of cerebral vasospasm(P=0.005<0.05),incidence of hydrocephalus(P=0.031<0.05),recurrence rate(P=0.018<0.05),the half-year postoperative GOS prognosis score(P＝0.002<0.05)was statistically significant The incidence of cerebral vasospasm and hydrocephalus in craniotomy clipping were high,but the recurrence rate of that was low.The univariate analysis of the prognosis and clinical data at the time of admission revealed that preoperative Hunt-Hess grades(P=0.000),preoperative CT Fisher grades(P=0.000),and surgical methods(P=0.003)were associated with prognosis of the patients.Among them,preoperative Hunt-Hess grades(Grades 4 and 5)(P=0.000,OR=0.050,95%CI= 0.017 to 0.145)were independent risk factors for poor prognosis of anterior circulation rupture IA.CONCLUSIONS:In patient with anterior circulation ruptured IA,except for patients with intracerebral hematoma who have a risk of cerebral herniation or have developed cerebral herniation,intravascular interventional embolization appears to be a choice with faster recovery,fewer complications,and better postoperative neurological recovery but higher recurrence rate.Regardless of whether the use of craniotomy or interventional embolization in the treatment of anterior circulation ruptured IA,the high preoperative Hunt-Hess grade is an independent risk factor for poor prognosis.