Mortality and Morbidity of Aneurysmal Neck Clipping during the Learning Curve

OBJECTIVE: Young neurosurgeons need to focus on the mortality and morbidity of aneurysmal neck clipping to develop a personal experience with an initial series. METHODS: Total 88 aneurysms from 75 patients who underwent neck clipping by the same operator from 2001 to 2004 were reviewed. Patients were divided into three groups: first year (Group I), second year (Group II), and third year (Group III) in each group. Location of aneurysm, age, Fisher grade, Hunter-Hess grade (H-H grade), postoperative Glasgow outcome scale (GOS), and complications related to surgical procedures were evaluated with Chi-square and logistic regression analyses. RESULTS: Fourteen patients had complications related to surgery (18.7%). The major causes of mortality and morbidity related to surgery were cerebral infarction, hemorrhage and brain swelling due to intraoperative rupture, brain retraction and vasospasm. Among the 4 cases of mortality were 2 patients in Group I, 1 patient in Group II and 1 patient in Group III, and location of aneurysms were 2 internal carotid artery(ICA) and 2 posterior communicating artery(PCoA) aneurysms. There were 4 morbidity and new neurological deficits in Group I, 4 in Group II and 2 in Group III. Although mortality and morbidity during the learning curve had a statistical significance in H-H grade, age (>60 years old), and aneurysm location (especially ICA aneurysm) as variables, mortality mainly occurred in ICA and PCoA aneurysms. CONCLUSION: Experienced supervision or endovascular approach should be considered for the treatment of ICA and PCoA aneurysms during the learning curve.

The comparison of aneurysmal necks measured on three dimensional reconstruction images of rotational DSA and those of traditional DSA / 介入放射学杂志

Objective To evaluate the value of three dimensional reconstruction images of rotational DSA on measuring aneurysmal necks and make a comparison with traditional DSA so as to provide more abundant and accurate informations for the enbolization of aneurysm. Methods A comparison was made between the measurement of aneurismal necks from 14 cases with traditional DSA examination and a measurement made on three dimensional reconstruction images of the same patient. Results There was a difference shown in the measurment of the aneurysmal necks between three dimensional reconstruction images of rotational DSA and those of traditional DSA, outcoming with more angles and data on three dimensional reconstruction images. Conclusions There are more angles of aneurysmal neck can be shown on rotational 3D DSA especially for the demonstration of the largest aneurysmal neck with a directional value for the intervention. (J Intervent Radiol, 2006, 15: 259-260)

Classification of Spatial Direction of Anterior Communicating Artery Aneurysm Based on the Neck Origin Site and the Fundus Projection

Most anterior communicating artery aneurysms arise in association with ipsilateral, dominant, proximal anterior cerebral artery(A1) segments and, as direct extensions of those vessels, are often somewhat directed toward the contralateral cerebral hemispheres. We classified the directions of the anterior communicating artery aneurysms based on three dimensional orientations of neck orifices and fundus projections which were then described schematically to demonstrate spatial orientations. We also analyzed 32 cases of anterior communicating artery aneurysm who had been operated on during recent 3.5 years according to this classification. Only the difference in the size of aneurysm in relation to the site of aneurysmal neck was statistically significant(p=0.0116), and there were no correlations between A1 hypoplasia and the site of aneurysmal neck, the projection of aneurysmal fundus and the size of aneurysm, and the intraoperative rupture and the projection of the aneurysmal fundus. Although meaningful clinical results could not be obtained, we believe this classification can be very helpful in planning traditional or endovascular surgeries for, and in understanding spatial directions of anterior communicating artery aneurysms.