Clinical Study On The Timing Of Operation And Prognostic Factors Of Poor Grade Intracranial Aneurysms

Objective To explore the influence of different factors on the clinical prognosis and the timing of operation of the poor grade intracranial aneurysms.Methods From January 2014 to January 2020,we conduct a retrospective study the clinical data of 213 patients with the poor grade intracranial aneurysms admitted to the General Hospital of Ningxia Medical University.The preoperative data consists of age,sex,smoking,hypertension,Hunt-Hess grade,Fisher grade,size of aneurysm and the parents’ artery spasm,and the postoperative data includes pneumonia,intracranial infection,recurrence and rebleeding of aneurysm,cerebral hernia and infarction.Outcome was assessed by modified Rankin scale(m RS)score.Univariate analysis and multivariate logistic regression analysis were used to determine the independent risk factors.The preoperative and integrated model include the preoperative independent risk factors and during the whole treatment.Based on the Logistic model,the preoperative and postoperative combining predictors were gained and applied to establish empirical and binormal model receiver operating characteristic(ROC)curves,the output model was good and poor prognosis.The model was calibrated by the Hosmer-Lemeshow test,and the judgment of prediction model was evaluated by the area under the curve(ACU).Results Among 213 patients,108(50.7%)had good prognosis and 105(49.3%)had poor prognosis.(1)Univariate analysis showed that the history of drinking and diabetes,WFNS V,endovascular treatment,re-bleeding,the cerebral vasospasm,the tracheotomy,infarction,preoperative cerebral hernia and postoperative cerebral hernia were the influencing factors of the prognosis(P < 0.05).(2)The independent risk factors include the WFNS V,the cerebral vasospasm,endovascular treatment,re-bleeding,preoperative cerebral hernia and infarction were showed by multivariate logistic regression analysis(P < 0.05).(3)Because there were differences among the groups according tomethods of treatment in different location of the aneurysms,the prognosis analysis of different methods in different parts of the aneurysms showed that the good prognosis rate of intravascular treatment for anterior cerebral and anterior communicating artery poor-grade aneurysms with m-Fisher III-IV grade(excluding preoperative cerebral hernia)was significantly lower than that of clipping(P =0.048),and the multivariate logistic regression analysis showed coil embolization(OR=21.960,P < 0.018,95% CI: 1.708-282.267)was also an independent risk factor.(4)The ROC curve analysis showed that the preoperative model including WFNS V,preoperative cerebral hernia and cerebral vasospasm had excellent discrimination with an AUC of 0.797(95% CI:0.738-0.857,P<0.001),and integrated model included the variables of preoperative model,pneumonia and infarction and herniation had excellent discrimination(AUC = 0.871,95%CI:0.823-0.919,P < 0.001).The good calibration of two models was evaluated by Hosmer-Lemeshow test,which indicated the good reliability of forecast and goodness of fit(P= 0.972 and 0.156,respectively).Conclusion In addition to improve WFNS V,preoperative cerebral hernia and relieve the arterial spasm,a low incidence of the postoperative complications,such as cerebral infarction and re-bleeding,can also play important roles in improving the prognosis.Treatment of poor-grade intracranial aneurysms within 72 h,especially avoiding surgery from3 to 7 days,can improve the prognosis.In addition,for patients with anterior cerebral and anterior communicating artery poor-grade aneurysms with m-Fisher III-IV grade(excluding preoperative cerebral hernia),the clipping is benefit to the prognosis of patients.