Abstract
Background We report the experience in managing intracranial aneurysms at our medical center. Methods We retrospectively analyzed 297 intracranial aneurysms managed during a 6-year period. Risk factors were analyzed with respect to their influence on outcome after surgery as measured by Glasgow Outcome Scale score. Results Fifty-eight patients had multiple aneurysms. Of all aneurysms, 83% were in the anterior circulation, 37% were unruptured, and 59% were larger than 10 mm in size. Good outcome was achieved in 75% of patients, and another 16% had fair outcomes. The mortality rate was 4%, and significant morbidity occurred in 5% of patients. Significant indicators of poor outcome were worsened clinical grade, posterior aneurysm location, and large aneurysm size. Conclusion Hypertensive patients, older patients, and patients with posterior circulation aneurysms had poorer neurologic status, which significantly influenced outcome. Larger aneurysms and vertebrobasilar aneurysms were associated with poor outcomes.
This content is limited to qualifying members.
If you have an existing account please login now to access this article or view purchase options.
Create a free account, then purchase this article to download or access it online for 24 hours.
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
References
References 1. Menghini VV, Brown RD Jr, Sicks JD, O'Fallon WM, Wiebers DO. Incidence and prevalence of intracranial aneurysms and hemorrhage in Olmsted County, Minnesota, 1965 to 1995. Neurology 1998; 51: 405–411.MenghiniVV]]BrownRD]]SicksJD]]O'FallonWM]]WiebersDOIncidence and prevalence of intracranial aneurysms and hemorrhage in Olmsted County, Minnesota, 1965 to 1995Neurology199851405 2. Jellinger K. Pathology of intracerebral hemorrhage. Zentralbl Neurochir 1977; 38: 29–42.JellingerKPathology of intracerebral hemorrhageZentralbl Neurochir19773829 3. Torner JC, Kassell NF, Wallace RB, Adams HP Jr. Preoperative prognostic factors for rebleeding and survival in aneurysm patients receiving antifibrinolytic therapy: Report of the Cooperative Aneurysm Study. Neurosurgery 1981; 9: 506–513.TornerJC]]KassellNF]]WallaceRB]]AdamsHPPreoperative prognostic factors for rebleeding and survival in aneurysm patients receiving antifibrinolytic therapy: Report of the Cooperative Aneurysm StudyNeurosurgery19819506 4. Le Roux PD, Elliott JP, Eskridge JM, Cohen W, Winn HR. Risks and benefits of diagnostic angiography after aneurysm surgery: A retrospective analysis of 597 studies. Neurosurgery 1998; 42: 1248–1255.Le RouxPD]]ElliottJP]]EskridgeJM]]CohenW]]WinnHRRisks and benefits of diagnostic angiography after aneurysm surgery: A retrospective analysis of 597 studiesNeurosurgery1998421248 5. Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL. The International Cooperative Study on the Timing of Aneurysm Surgery: Part 1—Overall management results. J Neurosurg 1990; 73: 18–36.KassellNF]]TornerJC]]HaleyEC]]JaneJA]]AdamsHP]]KongableGLThe International Cooperative Study on the Timing of Aneurysm Surgery: Part 1—Overall management resultsJ Neurosurg19907318 6. Gotoh O, Tamura A, Yasui N, Suzuki A, Hadeishi H, Sano K. Glasgow Coma Scale in the prediction of outcome after early aneurysm surgery. Neurosurgery 1996; 39: 19–25.GotohO]]TamuraA]]YasuiN]]SuzukiA]]HadeishiH]]SanoKGlasgow Coma Scale in the prediction of outcome after early aneurysm surgeryNeurosurgery19963919 7. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: Risk of rupture and risks of surgical intervention. N Engl J Med 1998; 339: 1725–1733.International Study of Unruptured Intracranial Aneurysms Investigators.Unruptured intracranial aneurysms: Risk of rupture and risks of surgical interventionN Engl J Med19983391725 8. Bellotti C, Oliveri G, Allegra G, Arrigoni M, Regalia F, Voci A, et al. Temporary clipping in the surgery of endocranial aneurysms. J Neurosurg Sci 1998; 42 (1 Suppl 1): 77–79.BellottiC]]OliveriG]]AllegraG]]ArrigoniM]]RegaliaF]]VociATemporary clipping in the surgery of endocranial aneurysmsJ Neurosurg Sci19984277 9. Rice BJ, Peerless SJ, Drake CG. Surgical treatment of unruptured aneurysms of the posterior circulation. J Neurosurg 1990; 73: 165–173.RiceBJ]]PeerlessSJ]]DrakeCGSurgical treatment of unruptured aneurysms of the posterior circulationJ Neurosurg199073165 10. Wirth FP, Laws ER Jr, Piepgras D, Scott RM. Surgical treatment of incidental intracranial aneurysms. Neurosurgery 1983; 12: 507–511.WirthFP]]LawsER]]PiepgrasD]]ScottRMSurgical treatment of incidental intracranial aneurysmsNeurosurgery198312507 11. Piepgras DG. Management of incidental intracranial aneurysms. Clin Neurosurg 1989; 35: 511–518.PiepgrasDGManagement of incidental intracranial aneurysmsClin Neurosurg198935511 12. Samson DS, Hodosh RM, Reid WR, Beyer CW, Clark WK. Risk of intracranial aneurysm surgery in the good grade patient: Early versus late operation. Neurosurgery 1979; 5: 422–426.SamsonDS]]HodoshRM]]ReidWR]]BeyerCW]]ClarkWKRisk of intracranial aneurysm surgery in the good grade patient: Early versus late operationNeurosurgery19795422 13. Bailes JE, Spetzler RF, Hadley MN, Baldwin HZ. Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg 1990; 72: 559–566.BailesJE]]SpetzlerRF]]HadleyMN]]BaldwinHZManagement morbidity and mortality of poor-grade aneurysm patientsJ Neurosurg199072559 14. Nowak G, Schwachenwald R, Arnold H. Early management in poor grade aneurysm patients. Acta Neurochir (Wien) 1994; 126: 33–37.NowakG]]SchwachenwaldR]]ArnoldHEarly management in poor grade aneurysm patientsActa Neurochir Wien199412633 15. Rordorf G, Ogilvy CS, Gress DR, Crowell RM, Choi IS. Patients in poor neurological condition after subarachnoid hemorrhage: Early management and long-term outcome. Acta Neurochir (Wien) 1997; 139: 1143–1151.RordorfG]]OgilvyCS]]GressDR]]CrowellRM]]ChoiISPatients in poor neurological condition after subarachnoid hemorrhage: Early management and long-term outcomeActa Neurochir Wien19971391143 16. Andrews RJ, Spiegel PK. Intracranial aneurysms: Age, sex, blood pressure, and multiplicity in an unselected series of patients. J Neurosurg 1979; 51: 27–32.AndrewsRJ]]SpiegelPKIntracranial aneurysms: Age, sex, blood pressure, and multiplicity in an unselected series of patientsJ Neurosurg19795127 17. McCormick WF, Schmalstieg EJ. The relationship of arterial hypertension to intracranial aneurysms. Arch Neurol 1977; 34: 285–287.McCormickWF]]SchmalstiegEJThe relationship of arterial hypertension to intracranial aneurysmsArch Neurol197734285 18. Stehbens WE. Etiology of intracranial berry aneurysms. J Neurosurg 1989; 70: 823–831.StehbensWEEtiology of intracranial berry aneurysmsJ Neurosurg198970823 19. Juvela S, Porras M, Heiskanen O. Natural history of unruptured intracranial aneurysms: A long-term follow-up study. J Neurosurg 1993; 79: 174–182.JuvelaS]]PorrasM]]HeiskanenONatural history of unruptured intracranial aneurysms: A long-term follow-up studyJ Neurosurg199379174 20. Ferguson GG. Physical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms. J Neurosurg 1972; 37: 666–677.FergusonGGPhysical factors in the initiation, growth, and rupture of human intracranial saccular aneurysmsJ Neurosurg197237666 21. Jane JA, Kassell NF, Torner JC, Winn HR. The natural history of aneurysms and arteriovenous malformations. J Neurosurg 1985; 62: 321–323.JaneJA]]KassellNF]]TornerJC]]WinnHRThe natural history of aneurysms and arteriovenous malformationsJ Neurosurg198562321 22. Jakobsson KE, Saveland H, Hillman J, Edner G, Zygmunt S, Brandt L, et al. Warning leak and management outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 1996; 85: 995–999.JakobssonKE]]SavelandH]]HillmanJ]]EdnerG]]ZygmuntS]]BrandtLWarning leak and management outcome in aneurysmal subarachnoid hemorrhageJ Neurosurg199685995 23. Yasui N, Magarisawa S, Suzuki A, Nishimura H, Okudera T, Abe T. Subarachnoid hemorrhage caused by previously diagnosed, previously unruptured intracranial aneurysms: A retrospective analysis of 25 cases. Neurosurgery 1996; 39: 1096–1101.YasuiN]]MagarisawaS]]SuzukiA]]NishimuraH]]OkuderaT]]AbeTSubarachnoid hemorrhage caused by previously diagnosed, previously unruptured intracranial aneurysms: A retrospective analysis of 25 casesNeurosurgery1996391096