Outcome of 337 intracranial aneurysms patients operated in a public hospital

Abstract

Many recent series of surgery for intracranial aneurysms have been based on experience of developed countries with great resources and a state of art health care. The purpose of the current study is to correlate the outcome of patients operated for intracranial aneurysms, reported from intensive high technology neurosurgical centers with the results of low technology, environment, where we practice. Between January 1986 and December 1996, 337 patients with intracranial aneurysms were operated on at the Servidores do Estado Hospital. We retrospectively reviewed the medical and radiologic records and compared the outcome of this group with other series derived from developed countries. The overall mortality of this series was 6.9%. Of the 313 good grades surgical patients, the mortality was 4.7% and the successful results were obtained in 88.8% individuals. We conclude that patients harboring intracranial aneurysms can be satisfactory handled in less developed nations, if a meticulous intraoperative technique is employed, even though sophisticated technology and equipment are not available.

Surgical management of intracranial aneurysms in the “coiling age”

“…There is great variability in the literature studies about aneurysm surgery, mainly about the clinical presentation of the patient at the time of surgery, the interval between the ictus and the operation and the criteria used to analyze signs and symptoms presented at the ictus and outcomes. 2,7,9,10,13 We observed an overall mortality of 12.1%, poor outcome of 8% and good outcome of 79.8%. When analyzed just patients with good grade before surgery, we observed a mortality of 6%, bad outcome of 5.1% and good outcome of 88.9%.…”

“…Other papers previously published in the literature, demonstrate operative mortal ity varying from 3% to 36%; excellent to good outcome varying from 63.6% to 94.7%; and poor outcome or death varying from 5.3% to 44.2%. 2,7,9,10,13 The low mortality and morbidity rates presented probably are, in some degree, related to the development of the endovascular treatment, once more adequate selection of patients for clipping is now feasible.…”

“…There is a trend to proceed with definitive aneurysmal surgery as soon as logistically possible, at least in patients with good clinical presentation. 10 However, there are no definitive data to support a universal policy of either early or late surgery. 10 The majority of our patients were submitted to late surgery (mean, 23 days), mainly because of referral patterns and crowded hospital, which resulted in the fact that majority of patients were admitted to our service several days after bleeding, making surgical treatment in the acute phase an extremely hard task.…”

Aneurisma paraclinóideo: técnica cirúrgica e resultados em 51 pacientes

“…o mesmo déficit visual do pré-operatório, dois desenvolveram déficits endocrinológicos e 2 hemiparesia contralateral; em 51 pacientes não ocorreu déficit neurológico. Lynch et al 32 relataram mortalidade geral de 6,9% em casos de aneurismas diversos.…”