Analysis Of The Influencing Multiple Factors Of The Prognosis After Clipping Aneurysms Of Anterior Willis's Circulation

OBJECTIVE: To find all kinds of significantly statistical indexes by analysing the influencing multiple factors of the prognosis after clipping aneurysms of anterior willis's circulation can be helpful to the surgical operation of anterior willis's circulation aneurysms, and also can help the patients obtain the best surgical outcomes.METHODS: Primitive clinical materials of 83 cases of anterior willis's circulation aneurysms which were clipped by neurosurgeons in Qilu Hospital of Shandong University from Jan. 2001 to Nov. 2003 were analysed by using Chi-Square Test, Mann-Whitney Test and Kruskal-Wallis Test. The influencing factors such as: sex, age, the aneurysm rupture times, the time interval between the last aneurysm rupture and the surgical operation, the consciousness in admission, the pre-operational Hunt-Hess grading , the pre-operational CT scan, the aneurysm site, the aneurysm number, the largest diameter of aneurysm, ventriculostomy or not, the postsurgical consciousness, the postsurgical paralysis or not, were analysed with the patients' Glasgow outcome scale(GOS), then we obtained the statistical results.RESULTS: The statistical results show as followed: 1. The relationship between sex and postsurgical outcome was analysed with Chi-Square Test, the result shows no statistical difference because of the p=0.97>0.05. It shows that there is nodifference between male and female in the postsurgical prognosis. 2. The relationship between age and postsurgical outcome was analysed with Kruskal-Wallis Test, the result shows statistical difference because of the p=0.047<0.05. It shows that old patients have poorer prognosis than the young ones , especially the ones older than 60 years old. 3. The relationship between the aneurysm rupture times and postsurgical outcome was analysed with Mann-Whitney Test, the result shows significantly statistical difference because of the p=0.000<0.01. It shows that the prognosis of patients with one-times rupture is better than the ones with more than one-times. 4. The relationship between the time interval between the last aneurysm rupture and the surgical operation and postsurgical outcome was analysed with Kruskal-Wallis Test, the result shows significantly statistical difference because of the p=0.008<0.01. It shows that the postsurgical prognosis of the long time interval is better than the short one. 5. The relationship between the consciousness in admission and postsurgical outcome was analysed with Chi-Square Test, the result shows significantly statistical difference because of the p=0.00<0.01. It shows that the patients with consciousness in admission have better postsurgical outcome than the ones with unconsciousness. 6. The relationship between the pre-operational Hunt-Hess grading and postsurgical outcome was analysed with Kruskal-Wallis Test, the result shows significantly statistical difference because of the p=0.00<0.01. It shows that the patients with low-grade pre-operational Hunt-Hess grading have better postsurgical outcome than the ones with high-grade grading, Grade I > Grade II > Grade III>Grade IV. 7. The relationship between the pre-operational CT scan and postsurgical outcome was analysed with Mann-Whitney Test, the result shows significantly statistical difference because of the p=0.00<0.01. It shows that the patients with intraventricular hemorrhage or intracerebral hematoma have poorer postsurgical outcome than the ones with simple subarachnoid hemorrhage(SAH). 8. The relationship between the aneurysm site observed intraoperatively and postsurgical outcome was analysed with Kruskal-Wallis Test, the result shows no statistical difference because of the p=0.385> 0.05. It shows that the aneurysm site has no direct relationship with the postsurgical outcome. 9. Therelationship between the aneurysm number and postsurgical outcome was analysed with Mann-Whitney Test, the result shows no statistical difference because of the p=0.577> 0.05. It shows that the aneurysm number has no direct relationship with the postsurgical outcome. 10. The relationship between the aneurysmal largest diameter and postsurgical outcome was analysed with Kruskal-Wallis Test, the result shows no statistical difference because of the p=0.479> 0.05. It shows that the aneurysmal largest diameter has no direct relationship with the postsurgical outcome. 11. The relationship between ventriculostomy or not and postsurgical outcome was analysed with Chi-Square Test, the result shows significantly statistical difference because of the p=0.001<0.01. It shows that the patients with ventriculostomy have poorer postsurgical outcome than the ones without ventriculostomy. 12. The relationship between the postsurgical consciousness or not and postsurgical outcome was analysed with Mann-Whitney Test, the result shows significantly statistical difference because of the p=0.000<0.01. It shows that the patients with postsurgical consciousness have better postsurgical outcome than the ones with postsurgical unnsciousness. 13. The relationship between the postsurgical paralysis or not and postsurgical outcome was analysed with Mann-Whitney Test, the result shows significantly statistical difference because of the p=0.000<0.01. It shows that the patients with postsurgical paralysis have poorer postsurgical outcome than the ones without postsurgical paralysis.CONCLUSIONS: 1. The patients' sex, aneurysm site, aneurysm number and the aneurysmal largest diameter have no direct relationship with patients' postsurgical outcome. 2. The postsurgical outcome is poor in old patients, espically in ones older than 60 years old. 3. The patients with more than one aneurysm rupture times have poorer postsurgical outcome than the ones with one aneurysm rupture times. The patients with long time interval between the last aneurysm rupture and the surgical operation have better postsurgical outcome than the ones with short time interval. 4.The patients with consciousness in admission have better postsurgical outcome than the ones with unconsciousness. 5.The patients with low-grade pre-operational Hunt-Hess grading have better postsurgical outcome than the ones with high-grade...