Analysis Of The Surgical Effect Of High-grade Intracranial Aneurysms

Objective:To explore the effect of different surgical treatment options on the prognosis of high-grade intracranial aneurysms,and to provide help for the treatment of high-grade intracranial aneurysms.Methods: A retrospective analysis of our hospital from May 2012 to May 2017 treated 67 cases of Hunt-Hess grade Ⅳ-Ⅴ intracranial aneurysm in patients with clinical data.There are 62 cases of grade IV aneurysm and 5 cases of grade Ⅴ.There were 20 cases of acute craniotomy due to intracranial hematoma resulting in cerebral hernia.Postoperative patients were followed up for 6 months,the Glasgow Outcome Scale(GOS),analysis of its mortality and good prognosis;no obvious intracranial hematoma choose to delay surgery in 47 cases,divided into two subgroups,of which craniotomy clipping 23 patients were enrolled in the study.24 patients were involved in embolization.Comparisons of case fatality rate,complication rate,hospitalization days and hospitalization costs were performed in two subgroups.Glasgow Outcome Scale(GOS)was compared between the two subgroups after 6 months of follow-up.Result:The patients in emergency craniotomy clipping group had good prognosis(4-5 points),8 cases(40%),poor prognosis(1-3 points),12 cases(60%)and 8 deaths(40%).In the delayed surgery group,the prognosis was good(4-5 points)in 14 cases(60.9%),and the prognosis was poor(1-3 points)in 9 cases(39.1%)and death in 5 cases(21.7%);The embolization group had a good prognosis of 21 cases(87.5%),poor prognosis(12.5%),and 2 deaths(8.3%).The prognosis of embolization group was better than delayed craniotomy clipping group(P <0.05).The postoperative mortality in the craniotomy clipping group was higher than that in the intervention group,but there was no significant difference(P> 0.05).The overall incidence of complications in the craniotomy clipping group was significantly higher than that in the intervention group(43.5% vs 16.7%,P <0.05).The cost of hospitalization in embolization group was higher than that in craniotomy clipping group(P <0.05),but there was no significant difference in hospitalization days(P> 0.05).Conclusion : High-grade intracranial aneurysms combined with intracranial hematoma resulted in a poor prognosis and high mortality after surgery,but also savedthe patient’s life to a certain extent.Patients with advanced intracranial aneurysm delay surgery with interventional embolization treatment are better than craniotomy clipping surgery,which can effectively improve the prognosis.