Analysis Of Prognostic Factors And Surgical Skills Of Microsurgery For Middle Cerebral Artery Aneurysms

Objective Middle cerebral artery aneurysms（MCAA）is a relatively common intracranial aneurysm,and microsurgery is still the main treatment method.By reviewing the clinical data of patients treated with microsurgery for middle cerebral artery aneurysm in our hospital,the risk factors and surgical techniques affecting the prognosis of microsurgery are discussed,and some references are provided for neurosurgeons to treat MCAA in the future.Methods The data of patients who visited the Second Affiliated Hospital of Anhui Medical University from January 2016 to December 2020,are diagnosed and received MCAA microsurgery in the hospital are collected.According to the GOS score at follow-up,they are divided into a good prognosis group and a poor prognosis group,the clinical data of the patients are recorded in detail,and the related statistical analysis was performed on the two groups of cases.Results The 14 factors that may affect the prognosis of surgery will be: gender,age,admission HH classification,admission modified Fisher classification,smoking history,hypertension,admission blood pressure（mean arterial pressure）,aneurysm location,aneurysm size,presence or absence of intracerebral Hematoma,timing of surgery,and complications are used as independent variables,and prognosis was defined as the dependent variable.Statistical univariate analysis showed that smoking history,admission Hunt-Hess classification,admission modified Fisher classification,intracerebral hematoma and complications are the factors affecting the prognosis of surgery.Significant effects are then included in multivariate binary Logistic analysis,showing that smoking history（OR=58.936,95%CI: 3.367-3207.396,P=0.015）,intracerebral hematoma,（OR=189.572,95%CI: 5.05-43293.269,P=0.017）and complications（OR=0.028,95%CI:0.001-0.249,P=0.007）are risk factors for poor surgical prognosis.For patients with ruptured aneurysm and hematoma,they are divided into two groups according to whether they underwent decompressive craniectomy.Univariate analysis showed that decompressive craniectomy（P>0.05）had no effect on prognosis.In addition,the patients are divided into 2groups according to the length of hospital stay.The multivariate Logistic regression analysis showed that complications（OR=0.191,95%CI: 0.054-0.593,P=0.006）are the risk factors affecting the length of hospital stay.The patients are divided into 2 groups according to the hospitalization cost.Multivariate Logistic regression analysis showed that aneurysm location（OR=2.352,95%CI:1.208-5.056,P=0.017）and aneurysm size（OR=3.029,95%CI: 1.187-8.525,P=0.025）was a risk factor affecting hospitalization costs.According to the follow-up results,there are 50 patients（79.4%）in the good prognosis group,13patients（20.6%）in the poor prognosis group,62 patients（98.4%）without recurrence of aneurysm,and 1 patient（1.6%）with recurrence.Conclusions Smoking history,intracerebral hematoma,and complications are significant risk factors for surgical prognosis.Decompressive craniectomy had no effect on the prognosis of patients with ruptured aneurysm and hematoma.Complications are risk factors affecting length of hospital stay,and aneurysm location and size are risk factors affecting hospital costs.Microsurgery is effective in treating middle cerebral artery aneurysms.Skilled anatomical knowledge and good intraoperative microsurgery are the keys to improving the curative effect.