Sandalcioglu I E, Schoch B, Regel J P, Wanke I, Gasser T, Forsting M, Stolke D, Wiedemayer H
Department of Neurosurgery , University of Essen Medical School, Hufelandstr. 55, D-45122, Essen, Germany.
Clin Neurol Neurosurg. 2004 Mar;106(2):88-92. doi: 10.1016/j.clineuro.2003.10.011.
The aim of this study was to evaluate the prognostic value of intraoperative aneurysm rupture (IAR) in patients with subarachnoid hemorrhage (SAH) undergoing surgery for cerebral aneurysms.
Between July 1997 and April 2000, 292 consecutive patients were admitted to our institution with SAH due to ruptured intracranial aneurysms. Of these, 169 patients were treated surgically according to standard microsurgical procedures and were included in this study. Mean age was 47 years. Initial clinical state was graded according to the classification of Hunt and Hess (HH). Outcome was classified according to the Glasgow Outcome Scale as favorable (grades IV and V) and unfavorable (grades I-III). Outcome of patients with intraoperative ruptured and non-ruptured aneurysms was analyzed in correlation to the preoperative clinical state and with respect to the time of surgery and to aneurysm localization.
Different rupture rates were observed with respect to the localization of the aneurysm: anterior circulation (n=69) 39.1%, middle cerebral artery (n=46) 34.8%, internal carotid artery (n=48) 31.2%, and posterior circulation (n=6) 16.7%. Patients with HH-grades I-III showed a favorable outcome in 72.2% (61 of 84 patients) without intraoperative rupture and in 71.7% (33 of 46 patients) with intraoperative aneurysm rupture. The corresponding values for patients with HH-grades IV/V were: favorable outcome in 34.6% (9 of 26 patients) and 23.1% (3 of 13 patients), respectively. Poor initial clinical condition (HH IV and V) as well as the initial Fisher grades III and IV were strongly associated with poor clinical outcome.
Intraoperative aneurysm rupture has no impact on the outcome, neither in patients with good initial condition nor for poor grades patients.
本研究旨在评估蛛网膜下腔出血（SAH）患者行脑动脉瘤手术时术中动脉瘤破裂（IAR）的预后价值。
1997年7月至2000年4月期间，292例因颅内动脉瘤破裂导致SAH的患者连续入住我院。其中，169例患者按照标准显微外科手术进行治疗并纳入本研究。平均年龄为47岁。初始临床状态根据Hunt和Hess（HH）分级进行分类。结局根据格拉斯哥预后量表分为良好（IV级和V级）和不良（I - III级）。分析术中动脉瘤破裂和未破裂患者的结局与术前临床状态、手术时间及动脉瘤位置的相关性。
观察到不同位置的动脉瘤破裂率不同：前循环（n = 69）为39.1%，大脑中动脉（n = 46）为34.8%，颈内动脉（n = 48）为31.2%，后循环（n = 6）为16.7%。HH分级为I - III级的患者中，术中未破裂者72.2%（84例中的61例）结局良好，术中动脉瘤破裂者71.7%（46例中的33例）结局良好。HH分级为IV/V级的患者相应数值分别为：良好结局者34.6%（26例中的9例）和23.1%（13例中的3例）。初始临床状况差（HH IV级和V级）以及初始Fisher分级为III级和IV级与不良临床结局密切相关。
术中动脉瘤破裂对初始状况良好的患者和病情较差的患者的结局均无影响。
