Outcome predicting factors in intracranial aneurysms: defining the complex aneurysms

ABSTRACT

The development of neurosciences has made the understanding and management of intracranial aneurysms better. It has been realized over the years that there may be a subgroup of patients who fare differently from the rest. The identification of factors which make the aneurysm different or complex may help in prognosticating patients. The aim of the current study was to identify such factors to assess how well they correlated with the outcome. Three-hundred-fourteen consecutive cases of spontaneous subarachnoid haemorrhage with intracranial aneurysms were retrospectively analyzed. Sixteen independent factors broadly categorized into three categories viz., patient related, radiological factors and surgery related factors were analyzed and their correlation with outcome studied. Univariate and multivariate analysis was done using logistic regression analysis and P values, and predictive values were determined. Five factors viz, WFNS grade 4-5, clinical vasospasm, smoking >/= 30 years, Fisher grade 3-4 and posterior circulation aneurysms were found to have highly significant association with poor outcome both using univariate and multivariate analysis. The clinical factors predominate and have more significant association with the outcome. The presence of factors viz, WFNS grade 4- 5, clinical vasospasm [DIND], smoking >/= 30 years, Fisher grade 3-4 and posterior circulation aneurysms were found to correlate with poor outcome and any of these factors could lead to poor outcome and are sufficient to label the patient as having a complex aneurysm