Treatment In Neurosurgery And Follow-up For Ruptured Intracranial Aneurysm

Purpose: To compare the effects of neurosurgical clipping versus endovascular coiling in patients with aneurysmal subarachnoid hemorrhage and to analyse the related factors of affecting the prognosis of patients with aneurysmal subarachnoid hemorrhage. Material and Method: To follow-up the patients with subarachnoid hemorrhagne(SAH) caused by ruptured intracranial aneurysm in our department from january 2008 to december 2009, 146 cases (119 with Hunt-Hessâ… -â…¡, 27 with Hunt-Hessâ…¢-â…¤) were achieved information, accounting for 53.87%. 79 aneurysms in 79 cases were assigned to clip, 30 aneurysms in 30 cases were assigned to coil and 37 aneurysms in 37 cases were chosen to be on observation. Results: when the discharge, in the surgical group, the number with good outcome was 69 (69 with Hunt-Hessâ… -â…¡), 6 (10 with Hunt-Hessâ…¢-â…¤), 1 case died, the average hospital stay was 22.7 days. In the endovascular treatment group, the number with good outcome was 26 (26 with Hunt-Hessâ… -â…¡), 2 (4 with Hunt-Hessâ…¢-â…¤), 1 case died, the average hospital stay was 13.4 days. In the conservtive treatment group , the number with good outcome was 19 (23 with Hunt-Hessâ… -â…¡), 1 case died, 3 (14 with Hunt-Hessâ…¢-â…¤), 3 case died, the average hospital stay was 8.3 days. After 3 months to 2 years' follow-up (10.3 months on average), in the surgical group, 76 cases (96.20%) with good outcome, 3 cases(3.80%)with bad outcome, 2 cases(2.53%)died, 1 case(1.27%) paralyzed, 1 of the 2 dead cases was died of severe cerebral edema after clipping, the other was died of rebleeding of aneurysm. In the endovascular treatment group, 28 cases (93.33%) with good outcome, 2 cases(6.67%)with bad outcome, 1 cases(3.33%)died, 1 case(3.33%) paralyzed, the dead case was died of cerebral ischemia after coiling. Outcome in the surgical and endovascular treatment groups, did not differ significantly (P>0.05). Imaging information, 63 cases of 79 cases were achieved follw-up in the surgical groups, 59 case(s93.65%)were complete occlusion. 21 cases of 30 cases were achieved follw-up in the encovascular treatment group, 19 cases(90.48%)were complete occlusion. The complete occlusion rate in the surgical and endovascular treatment groups, did not differ significantly (P>0.05). Conclusion: the recent clinical results and the outcome of follow-up between the surgical and endovascular treatment groups, both of them do not differ significantly (P>0.05). The complete clipping rate in the surgical group is higher than the complete coiling rate in the endovascular treatment group , they differ significantly (P<0.05). The average hospital stay in the endovascular treatment group is shorter than that in the surgical group, they differ significantly (P<0.05). The higer the case gets Hunt-Hess grade, the worse outcome it takes. The older the case is, the worse the outcome is.