| Objective:Multiple Intracranial Aneurysms(MIAs)refer to two or more intracranial aneurysms,including intracranial mirror aneurysms(Mir Ans)and non-mirror multiple aneurysms(n Mir Ans).The aim of this study was to explore the difference of clinical datas and the outcomes between Mir Ans and n Mir Ans,analyze the individualized treatment and prognostic factors of MIAs patients,reduce the mortality and disability rate,and improve the outcome of patients.Data and Methods: The clinical data of 76 patients with MIAs diagnosed and treated by neurosurgery in our hospital from January 2013 to October 2022 were collected and analyzed,including 29 cases in Mir Ans group and 47 cases in n Mir Ans group,respectively.Retrospective analysis was conducted to determine whether there were differences in age,gender,hypertension history,diabetes history,preoperative CT-Fisher grade,Hunt-Hess grade,number of aneurysms,treatment methods,postoperative complications,hospital stay and Glasgow Outcome Scale(GOS)between Mir Ans group and n Mir Ans group.Comparing the age,history of hypertension,preoperative CT-Fisher grade,Hunt-Hess grade,and surgical method grouping and stratification levels of the two groups of patients to see if there were any differences in the outcomes.According to the specific situation of MIAs patients,they were divided into three groups according to treatment methods: craniotomy group,intervention group,and craniotomy+intervention group,with 32 cases,37 cases,and 7 cases respectively;According to the timing of surgery,it was divided into the early group and the mid to late stage group,with 61 and 15 cases respectively;According to the surgical strategy,it was divided into a primary surgery group,a staging surgery group,and a group that only dealed with responsible aneurysms.The number of cases was 34,6,and 36,respectively.Univariate analysis was conducted on the preoperative clinical data and treatment related factors that affected the outcomes of patients with MIAs.Factors with P≤0.2 in univariate analysis were then included in a multivariate binary logistic regression analysis to analyze the clinical factors and independent risk factors that affected the outcomes of MIAs patients,P<0.05 indicates a statistical difference.Results: There was no statistical difference between Mir Ans group and n Mir Ans group in age,hypertension history,diabetes history,preoperative CT-Fisher grade,Hunt-Hess grade,number of aneurysms,treatment method,postoperative complications,hospital stay and GOS score(all P>0.05),but compared with n Mir Ans group,the prevalence rate of women in Mir Ans group was higher,with statistical difference(P=0.007<0.05).There was also no statistical difference between the two groups in terms of age,history of hypertension,preoperative CT-Fisher grade,Hunt-Hess grade and the level of surgical classification(P>0.05),while in the age>65 years group,the poor outcomes rate of the two groups was higher than that of the age<65 years group.In the group with hypertension history,the poor outcomes rate of patients in the two groups was higher than that in the group without hypertension.The poor outcomes rate of the two groups of patients in the CT-Fisher 3-4 level group before operation was higher than that of the CT-Fisher 1-2 level group.The poor outcomes rate of the two groups of patients in Hunt-Hess grade IV-V level group was higher than that of Hunt-Hess grade 0-Ⅲ group.In the craniotomy group,the poor outcomes rate of Mir Ans group was higher than that of n Mir Ans group.In the intervention group,the poor outcomes rate of patients in the two groups was close.Of the 76 patients with MIAs,64 had a good outcome(84.21%,64/76),and 12 had a poor outcome(15.79%,12/76).The outcomes of the three treatment groups(craniotomy,interventional and craniotomy+interventional group)was good in 27 cases,31 cases and 6 cases respectively;The outcome was poor in 5 cases,6 cases and 1 case respectively.The outcomes of the two groups(early,middle and late stage group)was good: 49 cases and 15 cases;There were 12 cases and 0 cases with poor outcome.The outcomes of the three surgical strategy groups(stage I,staging and only responsible aneurysm group)was good: 29 cases,6 cases and 29 cases;The outcome was poor in 5cases,0 cases and 7 cases respectively.The clinical univariate statistical analysis of the outcome of MIAs patients showed that the preoperative CT-Fisher grade,Hunt-Hess grade and age>65 years were correlated with the outcome of patients.However,gender,hypertension history,diabetes history,aneurysm side,aneurysm location,number of aneurysms,treatment methods,surgical timing and surgical strategies were not related to the outcome(P>0.05).The factors with P≤0.2 in univariate statistical analysis(age,hypertension history,preoperative CT-Fisher grade,Hunt-Hess grade and surgical opportunity)were included in the multivariate binary logistic regression analysis model.The results showed that the age of patients was an independent risk factor for the outcome(P<0.05).The older the age,the worse the outcome.However,the history of hypertension,preoperative CT-Fisher grade,Hunt-Hess grade and operation time were not correlated with the outcome of patients(P>0.05).Conclusion: Through comparative analysis,this study found that compared with n Mir Ans,women were more likely to suffer from Mir Ans.There was no statistically significant difference in the outcomes between the two groups,but the outcomes of the two groups of patients who were more than 65 years old,had hypertension,and were at the high level of Hunt-Hess and CT-Fisher grade was relatively poor.When craniotomy was selected,the outcome of Mir Ans group was worse than that of n Mir Ans group.This study analyzed the single factor affecting the outcomes of patients with MIAs and found that age>65 years old,preoperative CT-Fisher grade and Hunt-Hess grade were related to the outcomes of patients.Multivariate analysis found that the age of patients was an independent risk factor affecting the outcomes.Developing a reasonable and individualized plan of treatment based on the patient’s condition,specific conditions of the aneurysm,the surgeon’s experience,and hospital medical conditions can greatly reduce disability and mortality rates,and improve the outcomes of patients. |
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