Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal.
Department of Neurosurgery, St. George's Hospital, London, UK.
Br J Neurosurg. 2024 Oct;38(5):1086-1090. doi: 10.1080/02688697.2021.2022096. Epub 2021 Dec 30.
To analyse baseline characteristics of patients with intraoperative rupture (IOR) or non-IOR who underwent microsurgical clipping for ruptured intracranial aneurysms. Additionally, to asses functional outcome in terms of Glasgow Outcome Scale (GOS) at 6 and 12 months.
A retrospective analysis of 471 patients who underwent microsurgical clipping for ruptured intracranial aneurysms from 2007 to 2018 in Nepal Mediciti Hospital, Nepal. Patients who underwent surgery for unruptured aneurysm were excluded from the study. The association of the base line characteristic in IOR and non-IOR were analysed. Variables analysed were the Hunt and Hess Scale (HHS) dichotomized as (1-3) and (4-5), Modified Fisher Scale dichotomized as (0-2) and (3-4), type of rupture, use of brain retractor, timing of IOR during surgery, aneurysmal factors (size of the neck, location, lobulation) and time of surgery. Outcome, GOS dichotomized into favourable (4-5) and unfavourable (1-3), assessed at 6 months and 12 months.
Out of 471 patients treated for ruptured intracranial aneurysm, IOR occurred in 57 (12.10%) with mean age 49.47 (SD ±12.9), occurred more in smoker than non-smoker (45.6% vs. 18.6%; =.000) and regular alcohol consumers (36.8% vs. 17.9%; =.004). Favourable outcome with GOS (4-5) at 6 months was observed among patients with lower HHS (1-3), =.025 and lower MFS (0-2), =.04. However, outcome at 12 months was better associated with MFS (=.013) and aneurysm size (=.038), with more favourable outcome associated with aneurysm less than 10 mm.
Alcohol consumption and smoking are associated risk factors that may contribute to IOR. HHS and MFS are strong predictors of outcome for IOR patients at 6 months. However, at 12 months, MFS is more predictive of outcome. Aneurysms greater than 10 mm had a strong association with outcome at 12 months than 6 months.
分析接受颅内破裂动脉瘤显微镜夹闭术的术中破裂（IOR）或非 IOR 患者的基线特征。此外，根据格拉斯哥预后量表（GOS）评估 6 个月和 12 个月时的功能结局。
对 2007 年至 2018 年在尼泊尔 Mediciti 医院接受颅内破裂动脉瘤显微镜夹闭术的 471 例患者进行回顾性分析。本研究排除了接受未破裂动脉瘤手术的患者。分析了 IOR 和非 IOR 患者的基线特征。分析的变量包括亨特和赫斯量表（HHS）分为（1-3）和（4-5），改良费舍尔量表分为（0-2）和（3-4），破裂类型，脑牵开器的使用，术中 IOR 的时间，动脉瘤因素（颈的大小，位置，分叶）和手术时间。结局，GOS 分为有利（4-5）和不利（1-3），分别在 6 个月和 12 个月进行评估。
在 471 例颅内破裂动脉瘤患者中，57 例（12.10%）发生 IOR，平均年龄为 49.47（SD ±12.9），吸烟者多于非吸烟者（45.6%比 18.6%；=0.000）和规律饮酒者（36.8%比 17.9%；=0.004）。6 个月时，GOS 表现为有利（4-5）的患者 HHS 较低（1-3），=.025，MFS 较低（0-2），=.04。然而，12 个月时的结局与 MFS（=0.013）和动脉瘤大小（=0.038）的关系更为密切，与小于 10mm 的动脉瘤相关的结局更为有利。
饮酒和吸烟是导致 IOR 的相关危险因素。HHS 和 MFS 是 IOR 患者 6 个月时结局的有力预测因素。然而，在 12 个月时，MFS 对结局的预测更为准确。大于 10mm 的动脉瘤与 12 个月时的结局比 6 个月时的相关性更强。
