Lin Tzu-Kang, Hsieh Tsung-Che, Tsai Hong-Chieh, Lu Yu-Jen, Lin Chih-Lung, Huang Yin-Cheng
Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Acta Neurol Taiwan. 2013 Sep;22(3):106-11.
This clinical study was conducted to evaluate factors affecting outcome in the cases following major intraoperative rupture (MIOR) of the intracranial aneurysms.
Thirty cases with MIOR in a series of 467 surgeries for ruptured aneurysms were enrolled in this study. Clinical parameters, including: age, Hunt-Hess grading, Fisher grading, aneurysm size, aneurysm contour, operative timing, aneurysm location, and rupture timing were studied and compared with the prognosis in this particular cohort. The outcome was evaluated using the Glasgow Outcome Scale at least 3 months after surgery. Severe disability, vegetative survival, and death were classified as poor outcome.
Among the 30 cases with MIOR, 11 resulted in poor outcomes (36.7%). Age was an important prognostic factor in this cohort. Those patients with poor outcome after MIOR were significantly older than those with good outcome (mean age: 64.6 vs 51.4 years, P=0.006). In this study, a trend toward poor outcome was observed in cases with MIOR on internal carotid artery aneurysms (8/14, 57.1% vs 2/9, 22.2% and 1/6, 16.7% on middle cerebral artery and anterior communicating artery aneurysms, P=0.197, after adjustment for age factor). There was a higher incidence of a poor outcome when MIOR occurred during clip application (5/6, 83.3% vs 1/5, 20.0% and 5/19, 26.3% when MIOR happened during brain retraction and aneurysm dissection, P=0.041 after adjustment with the factor of age).
Although a larger sample population is required for a more conclusive result, MIOR occuring in older age, during clip application, or on an internal carotid artery aneurysm possibly has the trend to bear a worse outcome in the cohort of patients with MIOR during aneurysm surgery.
本临床研究旨在评估影响颅内动脉瘤术中大出血（MIOR）病例预后的因素。
在467例破裂动脉瘤手术系列中，纳入30例发生MIOR的病例。研究临床参数，包括：年龄、Hunt-Hess分级、Fisher分级、动脉瘤大小、动脉瘤轮廓、手术时机、动脉瘤位置和破裂时间，并与该特定队列的预后进行比较。术后至少3个月使用格拉斯哥预后量表评估预后。严重残疾、植物生存和死亡被归类为不良预后。
在30例发生MIOR的病例中，11例预后不良（36.7%）。年龄是该队列中的一个重要预后因素。MIOR后预后不良的患者明显比预后良好的患者年龄大（平均年龄：64.6岁对51.4岁，P=0.006）。在本研究中，观察到颈内动脉动脉瘤发生MIOR的病例有不良预后的趋势（14例中的8例，57.1%，而大脑中动脉和前交通动脉瘤分别为9例中的2例，22.2%和6例中的1例，16.7%，调整年龄因素后，P=0.197）。当MIOR发生在夹闭应用过程中时，不良预后的发生率更高（6例中的5例，83.3%，而当MIOR发生在脑牵拉和动脉瘤解剖过程中时分别为5例中的1例，20.0%和19例中的5例，26.3%，调整年龄因素后，P=0.041）。
尽管需要更大的样本量才能得出更确凿的结果，但在动脉瘤手术中发生MIOR的患者队列中，年龄较大、夹闭应用过程中或颈内动脉动脉瘤发生MIOR可能有预后较差的趋势。
