The Analysis Of The Efficiences Of Elderly People Who Have Undergone Operation With Ruptured Intracranial Aneurysms And Its Relative Prognosis

ObjectTo discuss elderly people’s results with ruptured intra-cranial aneurysms who have undergone neurosurgical operation or endovas-cular coiling and to illustrate the relative factors which would influence operation efficiency and prognosis.Material and methodRetrospectively analyzed clinical data and follow-up date in a consecutive series of249patients with ruptured intracranial aneurysms who were60years or older between January1,2006and December31,2010at Neurosurgical Department and interventional radiology center of XiangYa Hospital, it is divided into neurosurgical operation group(209patients) and endo-vascular coiling group(41patients). To discuss the relationship between relative factors and modified Rankin scale when patients leave hospital and after leaving hospital, these factors includes age、sex、ruptured times of aneurysms before operation、 Hunt-Hess grade、Fisher grade、Hypertension,Diabetes,Heart disease,Family history of cerebrovascular disease,aneurysm location、 size、number,treatment,surgical opportunity,intra-operative temporary blocking-up,postoperative complications. In the outcome analyses, modified Rankin scores were dichotomized into Rankin0to2(Independent survival) and Rankin3to6(Dependency or death). We follow-up patients from one year to six years through telephone、 outpatient service or write letters。ResultThere are208patients in craniotomy group, it include289aneurysms.203patients have completed surgical clipping operation (97.5%),2patients have completed surgical clipping and parcel operation (1.0%),1patient have completed parcel operation (1.0%)1patient has completed aneurysm removal and aneurysm wall’s suture operation (0.5%),1patient has completed aneurysm removal and anastomosis operation (0.5%)。8patients whose Head CT scan after operation get the results of intracranial hemorrhage carry out the operation of craniotomy hematoma-clearing; There are4people who are conducted ventriculo-peritoneal shunt because of hydrocephalus after surgery. There are4patients conduct decompressive craniectomy operation for late-occurred Vascular convulsive cerebral infarction and Cerebral edema.The Head CT scan reveals that27patients exist Vascular convulsive. And36patients suffer pulmonary infection after operation, and23tracheotomy for pulmonary。2patients have effusion under the scalp after operation。1patient cerebrospinal fluid rhinorrhea;2patient suffer optic nerve injury;4patients appear irritable gastror-rhagia and9patients have mental symptomsThe mRS varied, and there are165patients which rank0-2(79.3%),34patients which rank3-6(20.7%) when they left the hospital.Those who are followed-up are198, among these case, mRS varied, there are165which rank0-2;34which rank3-6(17.2%), and12people died which accounts for6.1per cent.There are41patients in endovascular embolization group, and it include55aneurysm.30patients have completed dense embolism (73.2%).There are6patients whose aneurysms neck residue(14.6%),4patients have completed part embolization (9.8%), and1patient fail to embolization (2.4%). The aneurysm bleed wwhen embolization in2patients,1patient had suffered herniation and death. Postoperative cerebral infarction in2patients, lung infection in1patients,3patients have mental symptoms.The mRS varied, and there are37patients which rank0-2(90.2%),4patients which rank3-6(9.8%) when they left the hospital.Those who are followed-up are39, among these case, mRS varied, there are35which rank0-2(87.2%);5which rank3-6(12.8%), and2people died which accounts for5.1per cent.We followed-up the patients of craniotomy group who left hospital and the scores of mRS, varied, and there are164which rank0-2,34which rank3-6. And we followed-up the group of Endovascular embolization who left hospital, and the scores of mRS, varied, and there are34which rank0-2,5which rank3-6.Totally, we followed-up237patients, there are198which rank0-2(83.5%),34which rank3-6(16.5%). Both the prognosis have no statistically significant differences. Single-factor Logistic regression analysis showed that age, whether the patient is unconscious during the period of illness, the preoperative Hunt-Hess classification, CT Fisher classification, preoperative aneurysm bleeding number of times, high blood pressure, postoperative complications associated with outcome (P<0.05). Multi-factor Logistic regression analysis show that age, high blood pressure, preoperative Hunt-Hess classification, CT Fisher classification, preoperative aneurysm bleeding number of times, postoperative complications associated with outcome (P<0.05), and it is not relevent with other factors (P>0.05).ConclusionElderly patients with rupture intracranial aneurysm should take active surgery operation. Microsurgical operation and interventional embolization have not statistically significant differences. The patients whose preoperative Hunt-Hess classification Ⅰ～Ⅲ, CT Fisher grading1-3levels show good prognosis. Preoperative Hunt-Hess grade, CT Fisher grade, older age, high blood pressure, preoperative aneurysm bleeding are independent risk factor of prognosis.