The Retrospective Study Of Operation Time And Prognosis Of Intracranial Aneurysm (the Report Of 560 Cases)

Object:To study the influencing factors of operation time and the prognosis with intracranial aneurysms and share in our experience.Methods:In this article,we retrospected and followed up 560 cases of intracranial aneurysm from July in 1993 to November in 2008,which were underwent microsugery treatment in China-Japan union hospital of JiLin university.These patients were divided into group by the preoperative Hunt-Hess scale,the location and size of intracranial aneurysm,age, the complication of patients before/after operation and the operation time.All data was analysised byχ~2 test(a=0.05).Results:Among 560 cases in disch,454(81.07%)got eusemia,189(79.08%)in the group of early surgery,49(64.47%) in the group of intermediate surgery and 216(88.16%) in the group of late surgery.Among 321 cases of follow-up,258(80.37%) got eusemia,111(77.62%) in the group of early surgery,22(56.41%) in the group of intermediate surgery and 125(89.93%) in the group of late surgery.Among 560 cases of surgery,111(19.82%) got new cerebral infarction after surgery,55(22.59%) in the group of early surgery,22(26.32%) in the group of intermediate surgery and 34(15.10%) in the group of late surgery.113(20.19%) cases sufferd intra- operational aneurysm rupture,41(17.15%) in the group of early aneurysm,16(21.05%) in the group of intermediate surgery and 56(22.86%) in the group of late surgery.178 cases(31.79%) were used temporary arterial occlusion,81(33.89%) in the group of early surgery,19(25.0%) in the group of intermediate surgery,and 78(31.84%) in the group of late surgery.Among 430 cases of the group of good scale(Hunt-HessⅠ～Ⅱ),376(87.4 4%) got eusemia,145(88.96%) in the group of early surgery,45(73.77%) in the group of intermediate surgery and 186(90.29%) in the group of late surgery;Among 93 cases of the group of worse scale(Hunt-HessⅢ),61(65.59%) got eusemia,30(57.69%) in the group of early surgery,3(33.33%) in the group of intermediate surgery and 28(87.25%) in the group of late surgery:Among 37 cases of the group of worst scale(Hunt-HessⅣ～Ⅴ),17(45.95%) got eusemia 11(45.83%) in the group of early surgery,1(16.67%) in the group of intermediate surgery and 5(71.43%) in the group of late surgery.Among 229 cases of the group of anterior cerebral artery aneurusms,192(83.84%) got eusemia,103(85.44%) in the group of early surgery,17(62.96%) in the group of intermediate surgery and 87(87.88%) in the group of late surgery;Among 125 cases of the group of median cerebral artery aneurysms,90(72.0%) got eusemia,50(65.79%) in the group of early surgery,7(53.85%) in the group of intermediate surgery and 55(91.67%) in the group of late surgery;Among 255 cases of the group of internal carotid artery aneurysms,205(80.39%) got eusemia,68(83.95%) in the group of early surgery,26(61.90%) in the group of intermediate surgery and 111(85.61%) in the group of late surgery;Among 7 cases of the group of post-circulational aneurysms,5(71.43%) got eusemia. Among 36 cases of the group of small aneurysms,31(86.11%) got eusemia,11(84.62%) in the group of early surgery,4(80%) in the group of intermediate surgery and 16(88.89%) in the group of late surgery;Among 313 cases of the group of medium-sized aneurysms,256(81.79%) got eusemia,121(84.03%) in the group of early surgery,32(66.67%) in the group of intermediate surgery and 103(85.12%) in the group of late surgery;Among 80 cases of the group of large aneurysms,69(86.25%) got eusemia,30(90.91%) in the group of early surgery,4(44.44%) in the group of intermediate surgery and 35(92.11%) in the group of late surgery;Among 18 cases of the group of giant aneurysm,13(72.22%) got eusemia,4(66.67%) in the group of early surgery,0(0) in the group of intermediate surgery and 9(81.82%) in the group of late surgery.Among 92 cases of the group of old patients(age≥60years),71(77.71%) got eusemia,32(76.19%) in the group of early surgery,3(37.5%) in the group of intermediate surgery and 36(85.71%) in the group of late surgery.Among 135 cases of the group of patients with hypertension 97(71.85%) got eusemia,50(67.57%) in the group of early surgery,8(61.54%) in the group of intermediate surgery and 39(81.25%) in the group of late surgery.Conclusion:Operation time is one of the most important infludencing factors of intracranial aneurysms;The outcome of late surgery is better than early surgery,while the prognosis of intermediate surgery is inferior;It has not dependability between intraoperational aneurysm rupture,the rate of temporary arterial occlusion and the operation time;It is very important to choosing suitable operation time according to the location,size and shape of aneurysms,the Hunt- Hess scale,general body state and age of the patients,which can obviously decrease the rate of disability and mortality.It is also necessary for patients with good sacle (Hunt-Hess scaleⅠ/Ⅱ) were treated as early as possible,while the patients who had complex aneurysm,SAH Hunt-HessⅢ/Ⅴor serious complications,late surgery is the optimization.