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

ABSTRACT

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.