Change of Management Results in Good-grade Aneurysm Patients

OBJECTIVE: The present study attempts to address the change of management results over time during the past 13 years in good-grade patients with intracranial aneurysm. METHODS: Six hundred twenty five (Hunt-Hess grade I to III) out of 826 patients with ruptured intracranial aneurysms operated by the same operator within 3 days after the attack from 1990 to 2002 were selected. Since 1998, endovascular aneurysmal occlusion was done in selected cases of 21 patients. The change of management results over time, including rebleeding rate, delayed ischemic neurologic deficit(DIND) as a cause of morbidity and mortality, and surgical outcome were examined. RESULTS: The ratio of poor-grade patients in all patients tended to decrease over the years. The early rebleeding rate declined from 5.0% to 1.2% with the use of tranexamic acid and computed tomography angiogram DIND as a cause of mortality and morbidity has decreased from 12.5% in 1990 to approximately 0% currently. Surgical outcome began to improve significantly in 1994 (poor outcome: 25% in 1990, 12.2% in 1994, 6.8% in 2002). CONCLUSION: These results suggest that the advances in care and increased experience of the operator significantly affect the change of overall outcome, and early detection of the aneurysm is needed for reducing the ratio of poor-grade patients.

Causes of Unfavorable Surgical Outcome in Cases of Preoperative Good-grade Aneurysm (Grades I, II)

The authors anaylzed 244 cases of good grade(Hunt-Hess I or II) intracranial aneurysm patients who underwent surgery between January 1984 to May 1995. Unfavorable outcome according to the Sundt scale, included surgical results which were fair or poor, and also patients who died, and was more prevalent in patients aged over 60, those with a history of hypertension, or in whom a basal blood clot thicker than 3mm, as seen on brain CT scan, or intraventricular hemorrhage was present. The main cause of unfavorable surgical outcome was technical failure(47%), and the other causes were delayed vasospasm, cerebrovascular accident(CVA) and hydrocephalus. The results suggest that in good-grade aneurysm(grade I or II), prudent surgical techniques, aggressive early treatment for vasospasm, the prevention of perioperative CVA, and proper management of hydrocephalus lead to a better outcome.