Surgical Experiences for Intracranial Aneurysms(3,000 Cases)

Sim, Jae Hong; Jeong, Young Gyun; Lee, Sun Il; Jung, Yong Tae; Kim, Moo Seong

Abstract

OBJECTIVE
The present study evaluated overall surgical results for 3,000 patients with intracranial aneurysms, operated on in Busan Paik Hospital institution.
METHODS
Three thousand aneurysm cases, operated on in Busan Paik Hospital between January 1980 to June, 15th, 2005, were evaluated based on the following criteria;aneurysm form, aneurysm location, surgical results, postoperative complications, and seasonsonality of occuence. 957 cases were anterior communicating artery aneurysms, 776 were internal carotid artery(ICA) aneurysms, 755 were middle cerebral artery(MCA) aneurysms, 96 were anterior cerebral artery(ACA) aneurysms, 128 were vertebro-basilar artery(VBA) aneurysms and 288 were multiple aneurysms. The male to female ratio was 0.7 to 1. Surgical methods included 2,738 clippings, 219 coating and wrappings, 23 aneurysmoraphies, 20 proximal ligations.
RESULTS
Rebleeding occured in 5.1% of the early operation group and 16% of the late operation group respectively. Incidence of clinical vasospasm was 16.6% and angiographic vasospasm was 24.1%. The percentage of the multiple aneurysms was 9.5%, the percentage of the dissecting aneurysm was 6 cases (0.2%), 6 of the total (0.2%);De Novo" aneurysm, the percentage of lobectomies with clipping cases was 9 cases (0.3%), the percentage were incidental aneurysms;164 (5.5%). 88.1% had overall favorable surgical results with a 5.5 % mortality rate. Calcium-channel blocker and "Triple H" therapy did not improve mortality but did significantly improve morbidity. In the old age group, early operation reduced vasospasm, rebleeding and medical complications. The early surgery group exhibited a 86.2% favorable outcome with a 8.1% mortality rate. Intraoperative angiography reduced residual or remained aneurysms in large, giant aneurysm, especially in A.com artery aneurysm.
CONCLUSION
The surgical results for the early surgery group according to surgical timming was better, but there were not statistically significant. ntraoperative angiography was especially useful on large aneurysms of the anterior communicating artery.