An Analysis of Follow up Results of 1500 Intracranial Ruptured Aneurysms with Surgery

Choi, Chang Rak; Rha, Hyoung Kyun; Lee, Kyoung Jin; Park, Hae Kwan; Park, Sung Chan

Abstract

The surgical results of 1500 patients with intracranial aneurysms operated in the neurosurgical department of our university hospital during the 17 year period from 1978 to 1994 were analysed with regard to the preoperative neurological status, preoperative CT findings and timing of surgical intervention. On the follow up examinations taken between 6 months to 9 years after operations, 1115 patients(74.3%) were classified as those having a good recovery, but 206 patients(13.7%) and 88 patients(5.9%) suffered some morbidity(fair and poor outcome respectively), and 91 patients(6.1%) died. Surgical results for the patients with good neurological status at admission were generally good: good outcome for the patients with Hunt and Hess grade 1 was 87.8% and that for those with grade 2 was 80.9%, while it was 29.6% and 6.7% for patients with grade 4 and 5, respectively. There was no difference of the rate of good outcome between early(0 to 3 days after bleeding) and late surgery(14 days or more after subarachnoid hemorrhage) groups, if poor graded cases were excluded from the early surgery group. Outcome was worse if the surgery was performed during the period between 4th and 10th days after initial bleeding. The major causes of unfavorable outcome(poor and dead) were initial hemorrhagic insults and delayed ischemic deficits. For further improvement of the overall surgical outcome, several factors must be concerned. First, early surgical intervention is recommended in good grade patients on admission but it should probably be delayed in patients with poor grades. Second, active management of poor grade patients should be scrutinized. Third, incidence of delayed ischemia may be lowered with positive consideration and preventive treatment towards vasospasm.