One-year outcome in early aneurysm surgery: a 14 years experience

Abstract

In a consecutive series of 1150 patients with cerebral aneurysms diagnosed in our department by angiography or autopsy between the years 1977-1990, 1007 patients underwent definitive operative treatment of their aneurysms mainly by early surgery. More than half (55%) were operated on during the first three days after subarachnoid haemorrhage (SAH), and more than three quarters (77%) during the first week. The surgical mortality at 30 days was 9%; at one-year follow-up 13% had died. The total management mortality was 22%. The 618 patients presenting in Hunt and Hess Grades I-II had a 4% mortality, and 90% had an independent life at follow-up; 270 Grade III patients had a 19% mortality and 68% were independent. There were 99 patients operated on in Grades IV-V with a 46% mortality and 30% were independent. Age of the patient and size of the aneurysm were strongly related to outcome; however, many of the giant aneurysms were operated on as an emergency because of large intracerebral haematomas. Best results were obtained in the anterior communicating artery (ACA) area; the lowest rate of useful recoveries was in the vertebro-basilar artery (VBA) area (71%). Early surgery did not prevent delayed ischaemic deficits. During the first 72 hours patients in Grades I-III can be operated on safely with good results. The results in Grades IV-V are poor, and we suggest that only cases with large haematomas or considerable hydrocephalus or those improving should be operated on in the first days after SAH, with limited hopes of functional recovery.

Outcomes of Early Endovascular Versus Surgical Treatment of Ruptured Cerebral Aneurysms

“…These variables are also comparable to those presented in the international cooperative study 3,4 and in our previous study of 1007 patients, 2 with the exception of the large proportion of excluded middle cerebral artery aneurysms (Table 1), the most common aneurysms in our institution. 38 …”

“…of outcome also in most surgical [1][2][3][4]35,39 and in many endovascular [13][14][15][16][17][18]40 series.…”

“…espite developments in the treatment of acute aneurysmal subarachnoid hemorrhage (SAH), the case fatality rate has remained stable, [1][2][3][4][5][6][7] although the outcomes of good-grade patients with anterior circulation aneurysms have improved significantly. 8 A recent study 9 on the natural history and treatment of unruptured aneurysms has suggested that surgery itself could produce cognitive impairment, neurological morbidity, and mortality more frequently than previously believed.…”

21 Endovascular Treatment of Posterior Circulation Aneurysms

“…Overall both QOL score and modified Rankin scale were influenced by age, showing a decreasing percentage of patients with good and excellent outcomes in the older age groups. The results of several series of patients with ruptured and unruptured intracranial aneurysms, where patient age has been identified in as an independent predictor of long-term clinical outcome were similar Hernesniemi et al 1993;Deruty et al 1995;Yoshimoto and Kwak 1995;Khanna et al 1996). Gender did not contribute significantly, which is also in agreement with previously published data.…”

Cerebral Aneurysms

“…In the series of Hernesniemi et al (27), epilepsy was seen in approximately 14% of patients with acute aneurismal SAH who were treated surgically and who were still alive two months after treatment. Keranen et al (45) reported an overall frequency of 14% of late epilepsy in surgically treated patients with supratentorial aneurysms; 2.5% in patients with preoperative Hunt&Hess grade I and 33% in patients with Hunt&Hess grade III-V. Ukkola et al (83) reported a lower frequency of 8% of secondary epilepsy in their series of 183 consecutive patients operated on for ruptured aneurysms.…”