Early experience with surgical management of cerebral aneurysms: report of 32 cases

ABSTRACT

To review the results of surgical intervention in 32 patients with cerebral aneurysms aiming to find out the pitfalls and lessons one can learn from this early experience with aneurysm surgery. The clinical, radiological and operative data of 32 patients operated for cerebral aneurysms were correlated with 3-month clinical outcome. Clinical data included age, gender and clinical grading according to the World Federation of Neurological surgeons classification. Radiological data included site, size, neck size of the aneurysm, and the presence of associated vasospasm, intracerebral hemorrhage, and/or hydrocephalus. Operative data included brain swelling, intraoperative aneurysm rupture, temporary clipping of parent vessels, and difficult clipping. Outcome was assessed according the Glasgow outcome score [GOS]. Out of 32 patients, 25 [78.1%] had favorable outcome [GOS 3 and 4], and 7 [21.9%] had unfavorable outcome [GOS 0, 1 and 2]. All early-operated grade 4- and 5-patients died [n=4]. On the other hand, unfavorable outcome was observed in 22% of grade 3-patients and in 5% only of grade 1- and 2-patients. Meanwhile, the following factors were associated with unfavorable outcome: brain edema [40%], vasospasm [33.3%], temporary clipping [55.5%], intraoperative rupture of aneurysm [57%]. These factors were frequently observed in early-operated grade 3-, 4- and 5-patients. In grade 3-, 4- and 5-patients, unfavorable outcomes associated with early- and late-surgery were 83% and 14%, respectively. When early-operated grade 3-, 4- and 5-patients were eliminated from the analysis, the incidence of unfavorable outcome decreased to less than 8%.In order to minimize the postoperative morbidity and mortality in newly-developed neurovascular centers, it would be recommended to avoid early surgical intervention for patients in grade 3, 4 and 5