The Outcome of Surgical Management in Patients with Ruptured Anterior Communicating Artery Aneurysm

Park, Sang Keun; Kim, Tae Hong; Kwon, Jum Dae; Kim, Sang Jin; Shin, Hyung Shik

Abstract

The purpose of this study was to assess the outcome of management in 123 patients who underwent surgery for a ruptured anterior communicating artery aneurysm, the period covered is August 1989 to January 1996. The outcome of surgical management was based on four primary factors : Clinical condition on admission(Hunt and Hess Grade) ; The distribution of hemorrhage, as seen on brain computerized tomography(Fisher Grade) ; The presence of delayed ischemic deficits ; And the time between aneurysmal rupture and surgery. Other conditions contributing to surgical outcome are reviewed. On the basis of the patients' status on discharge, the outcome was as follows : good, 92 patients(74.8%) ; fair, 11(8.9%) ; poor, 14(11.4%) ; and died, six(4.9%). The best results were for patients with grades I and II(H and H grade). Thirty-three of 40 who underwent early surgery(within 3 days) were rated as good, while 54 of 64 for whom surgery was delayed(after 7 days) showed a favorable result ; thus, outcome did not depend on whether treatment was early or delayed. The least favorable outcomes(poor or died) were attributed to massive hemorrhage, delayed ischemic deficits, infections(cerebritis and ventriculitis, for example) or rebleeding. Other pertinent factors influencing surgical outcome were the direction or shape of the aneurysm, multiplicity, perioperative premature rupture of aneurysms, and temporary clipping of proximal vessels. To improve management outcome, it is stressed that intensive care should be started as soon as an aneurysmal rupture is evident, and sterile manipulation should also be applied.