Authors compared the surgical outcome of ruptured intracraniai aneurysms in all of 400 patients with their age, sex, admission day from ictus and history of hypertension. The radiological findings with Fisher grade of subarachnoid hemorrhage, hydrocephalus, aneurysmal multiplicity, location of aneurysm, size of aneurysm and the intervals and incidences of clinical vasospasm and rebleeding were investigated. The relationship between preoperative neurological grade and early versus late surgical outcome, causes of unfavorable outcome in the aggravated group were evaluated together. And they were analyzed statistically with a multiple logistic regression model for the retrospective research of the 10 years period from 1984 to 1993.
The results were as follows:
1) Age ranged from 19 to 78 years old and the mean of them was 52 years old. The proportion of male and female was each 154 cases (38.5%) and 246 cases(61.5%) and the ratio of them was 1:1.6.
2) The 105 cases (26.2%) of the early surgery (ES) operated less than 3 days from ictus, and the 295 cases (73.8%) of the late surgery (LS) operated with the lapse of more than 3 days from ictus.
3) The duration of hospitalization distributed from a day to 444 days and the average period of them were 26 days in the case of ES and 42 days in the case of LS respectively.
4) The distribution of the preoperative neurological grade appeared 6.7% in grade 1, 67.8% in grade 2, 12.3% in grade 3, 9.3% in grade 4 and 3.0% in grade 5 by Hunt and Hess classification respectively.
5) The history of hypertension were noted each 49 cases in the ES and 130 cases in the LS, and the percentage of them was 45% of all.
6) The proportion of the Fisher grade from 1 to 4 appeared 7.5%, 47.3%, 24% and 17.2% in order respectively.
7) The hydrocephalus occurred 15 cases in the ES and 47 cases in the LS.
8) The radiological finding of aneurysmal multiplicity revealed to 353 cases (88.2%) in single, 39 cases (9.8%) in two and 8 cases (2.0%) in more than three of aneurysms respectively. The site of ruptured aneurysm noted anterior communicating artery in 141 cases (35.2%), internal cerebral artery in 121 cases (30.2%), middle cerebral artery in 107 cases (26.8%), anterior cerebral artery in 19 cases (4.8%) and vertebro-basilar artery in 12 cases (3.0%) respectively. The size of aneurysm was less than 3mm in 15 cases (3.7%), 3∼10mm in 302 cases (75.5%), 11∼25mm in 78 cases (19.5%) and more than 25mm in 5 cases (1.3%).
9) The intervals of clinical vasospasm were less than 3 days in 9 cases, between 4∼7 days in 18 cases, between 8∼14 days in 19 cases, between 15∼21 days in 7 cases, more than 21 days in 6 cases and their incidence occurred to 14.8%. The intervals of rebleeding were less than 3 days in 9 cases, between 4∼7 days in 8 cases, between 8∼14 days in 4 cases, between 15∼21 days in 4 cases, more than 21 days in 3 cases and their incidence occurred to 7%.
10) The causes of unfavorable outcome were initial massive bleeding in 44 cases, delayed ischemic deficit in 11 cases, surgical procedure in 10 cases, medical problem in 2 cases, hydrocephalus in one case and others in 2 cases. The follow-up periods following discharge ranged from one month to more than 24 months in 221 cases (55.3%) of all.
11) In the cases of ES, the percentages of the improved group including a good recovery and moderate disabled state, and those of the aggravated group including a severe disabled state, vegetative state and death were 85% and 15% respectively according to Hunt grade 1, 2 and 3 at admission. In the case of LS, those of the improved groupand the aggravated group were 90% and 10% respectively, but there were not significant to the surgical outcome with the time difference between early and late surgery (P>0.05). Factors affecting the surgical outcome were rebleeding, clinical vasospasm and past history of hypertension (P<0.05).
In conclusion, the decision of operation timing between early and late surgery must be considered according to the preoperative neurological grade with the above mentioned prognostic factors and additional supports of the prospective study.
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