| Objective To study the prognosis in different surgical timing and the related factors to it of neurosurgical procedures or endovascular treatment in patients with intracranial aneurysms.Methods 1071 patients with intracranial aneurysms were reviewed between January 2003 and November 2008.Except for the data of 35 for various reasons,the other 1036 patients with intracranial aneurysms were treated with neurosurgical procedures or endovascular treatment. 837 patients were treated with neurosurgical procedures, including 814 patients with surgical clipping with the neck of the aneurysms, 7 with trapping of the aneurysms, and 15 with ligation of the carotid, 1 with isolated aneurysm.199 patients were treated with endovascular interventions, including 166 embolization, 18 embolization with stent, 14 with only stenting technique, and only one with balloon technique.Prognosis after discharge in patients between the two interventions in early operation, intermediate operation and postponed operation were compared. Discuss the relationship between prognosis and age, hypertension, Hunt-Hess Scale, Fisher Scale and determine how the different timing of operation affect the prognosis. The results was analysed by SPSS (version 14.0). A 2-tailed probability value of <0.05 was considered to be statistically significant.Results1. The MRS degree estimate at dischargeThe MRS degree estimate at discharge shows the eusemia in the groups of early operation, intermediate operation and postponed operation were 84.67%, 76.31%, 86.73%, respectively, there is statistical significance among the three different timing of operation. Mortalities of the three group were 1.46%,1.87%,2.21%, respectively, there is no statistical significance among them.2. The effect of preoperative relative factors to PrognosisSingle factor analysis shows that the unfavorable prognosis of intracranial aneurysms patients who have hypertension were more then who don't have hypertension. The prognosis of patients in the I,II,III degree of Hunt-Hess scale have no relationship with timing of operation ,patients in the IV degree have better prognosis in the early treatment group then the other two groups. The prognosis of patients in different degree of Fisher scale and age have no relationship with timing of operation.There is no significance in unfavorable prognoses among the early operation, intermediate operation and postponed operation under endovascular treatment,but have statistical significance in neurosurgical procedures. Further analysis shows that unfavorable prognosis between early operation and intermediate operation, intermediate operation and late operation have statistical significance, but ins't statistically significant between early operation and postponed operation.3. The influencial factors of endovascular treatmentThe Prognosis of the 199 patients who treated by the endovascular treatment shows there in no statistical significance in unfavorable prognosis in dinfferent timing of operation,but patients in early operationin group have less embolism then the other two groups.4. The intraoperative and postoperation complicationThere are 212 casse and 27 cases have intraoperative and postoperation complication under neurosurgical procedures and endovascular treatment, respectively. The majority of them are nervous system complication,including intraoperative aneurysms bleeding, postoperation conscious disturbance, limbs dyscinesia, postoperation dropsy of brain and postoperation aneurysms rebleeding. The intraoperative and postoperation complication occured in different timing of operation have no statistical significance.ConclusionUnfavorable prognosis occurred in patients treated by Endovascular treatment have no statistical significance in different timing of operation.Early opreration tends to result in more embolism than intermediate operation and postponed operation. Patients classified to higher degree in Hunt-Hess Scale and Fisher Scale and have hypertension all got unfavorable prognosis no matter choose what time to operate. Early opreration and postponed operation lead to the same operative effect to intracranial aneurysms,but intermediate operation lead to baddish effect.Patients who are already in the intermediate stage when admited shuould be operated as earlier as possible. |
