ABSTRACT
Objective To analyze the incidence and predictors of chronic subdural hematoma (CSDH) after surgical clipping between unruptured intracranial aneurysms (UIAs) and ruptured intracranial aneurysms (RIAs).Methods A retrospective cohort study was adopted to collect 486 cases of aneurysm patients (102 cases of UIAs patients and 384 RIAs patients) closed by aneurysm surgery who were admitted to the department of neurosurgery of The Fifth People's Hospital of Chengdu from October 2009 to December 2017.The clinical data,preoperative and postoperative imaging data and postoperative follow-up results were collected.The incidence of CSDH after operation in UIAs patients and RIAs patients was compared.The risk factors of CSDH after UIAs and RIAs patients were analyzed by multivariate Logistic regression model.Results The incidence of CSDH in UIAs and RIAs patients (10.78％ vs 3.13％,x2 =10.487,P =0.001) and the reoperation rate after CSDH (3.92％ vs 0.78％;x2 =5.599,P =0.018) were all statistically different,all of which showed that the patients with UIAs were higher than those of the patients with RIAs.Brain atrophy of grade 3-4 (OR =1.978,95％ CI:1.939-2.030,P ＜ 0.001),subdural effusion CT value ≥40 (OR =3.394,95％ CI:2.908-3.867,P ＜ 0.001) and subdural effusion (OR =2.872,95％ CI:2.648-3.019,P ＜0.001 grade) of Ⅰ B are independent risk factors of CSDH in patients with UIAs after aneurysm clipping (P ＜0.05).Subdural effusion CT value ≥ 40 (OR =3.442,95％ CI:2.918-3.8769,P ＜ 0.001) and grade Ⅰ B subdural effusion (OR =2.329,95％ CI:2.011-2.564,P ＜ 0.001) are independent risk factors for CSDH in patients with RIAs after aneurysm clipping (P ＜0.05).Conclusions The incidence of CSDH after aneurysm clipping in UIAs patients was significantly higher than that of RIAs patients.The risk factors for CSDH in the two groups were not the same.
ABSTRACT
Objective To retrospectively analyze and compare the intraoperative and postoperative clinical efficacies between the interhemispheric approach and pterional approach in craniotomy anterior communicating aneurysm clipping surgery.Methods A total of 21 cases of anterior communicating artery aneurysms with subarachnoid hemorrhage undergoing surgery of craniotomy clipping from January 2012 to December 2016 in the Department of Neurosurgery of Shengjing Hospital of China Medical University,in which 13 cases were treated by pterional approach and 8 cases were treated by interhemispheric approach.Two kinds of operation approaches were compared in operation time,intraoperative aneurysm rupture rate,intraoperative bleeding volume,average length of stay,incidence rate of postoperative fection,and Glasgow Outcome Scale (GOS).Results There were no significant difference in intraoperative aneurysm rupture rate,intraoperative bleeding volume,inicidence rate of postoperative infection rate,and GOS scores (P ＞ 0.05).But the opreration time and average length of stay in interhemispheric approach group were significantly shorter than the pterional approach group (P ＜ 0.05).Conclusions Approach of interhemispheric was a safe,effective,and convenient approach for the craniotomy of clipping in anterior communicating artery aneurysm.
ABSTRACT
Objective To retrospectively analyze and compare the intraoperative and postoperative clinical efficacies between the interhemispheric approach and pterional approach in craniotomy anterior communicating aneurysm clipping surgery.Methods A total of 21 cases of anterior communicating artery aneurysms with subarachnoid hemorrhage undergoing surgery of craniotomy clipping from January 2012 to December 2016 in the Department of Neurosurgery of Shengjing Hospital of China Medical University,in which 13 cases were treated by pterional approach and 8 cases were treated by interhemispheric approach.Two kinds of operation approaches were compared in operation time,intraoperative aneurysm rupture rate,intraoperative bleeding volume,average length of stay,incidence rate of postoperative fection,and Glasgow Outcome Scale (GOS).Results There were no significant difference in intraoperative aneurysm rupture rate,intraoperative bleeding volume,inicidence rate of postoperative infection rate,and GOS scores (P ＞ 0.05).But the opreration time and average length of stay in interhemispheric approach group were significantly shorter than the pterional approach group (P ＜ 0.05).Conclusions Approach of interhemispheric was a safe,effective,and convenient approach for the craniotomy of clipping in anterior communicating artery aneurysm.