Biluts Mersha Hagos, Bogale Megerssa Thomas
Department of Neurosurgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Myungsung Christian Medical Center, Department of Neurosurgery, Addis Ababa, Ethiopia.
World Neurosurg X. 2024 Mar 10;23:100363. doi: 10.1016/j.wnsx.2024.100363. eCollection 2024 Jul.
In this ambispective cohort study, the authors share their experience with surgical outcomes of intracranial aneurysms in a resource-limited setting.
The study spans a 10-year period (January 2010 to December 2022) at Myungsung Christian Medical Center (MCM) in Addis Ababa, Ethiopia. Patient data, aneurysm characteristics, preoperative, intraoperative, and postoperative factors, along with patient outcomes, were collected using a structured questionnaire. Data analysis employed SPSS version 25, utilizing descriptive statistics and Multivariable logistic regression to identify independent predictors of outcomes. The primary outcome measure was the Glasgow Outcome Scale (GOS) at discharge.
The study included 71 patients with ruptured intracranial aneurysms, with 63 aneurysms clipped in 62 patients. No sex predilection was observed. Aneurysms were predominantly in the anterior cerebral circulation (98.6%), with 60.6% in the anterior communicating artery. Aneurysm size was less than 10 mm in 75.76% of cases. Favorable outcomes were achieved in 83.9% of patients, while 16.10% had unfavorable outcomes. Unfavorable outcomes correlated with a worsening neurological grade assessed by the Glasgow Coma Scale (GCS). The occurrence of delayed vasospasm and hemiparesis showed strong predictive value.
The study demonstrated acceptable mortality and favorable outcomes. Patient outcomes in ruptured cerebral aneurysms were primarily influenced by non-modifiable factors, such as GCS on admission and neurological deficit. GCS exhibited a superior predictive value for outcomes compared to commonly used WFNS and Hunt-Hess scales in patients with intracranial aneurysms.
在这项回顾性队列研究中，作者分享了他们在资源有限的情况下治疗颅内动脉瘤的手术结果经验。
该研究在埃塞俄比亚亚的斯亚贝巴的明成基督教医疗中心（MCM）开展，为期10年（2010年1月至2022年12月）。使用结构化问卷收集患者数据、动脉瘤特征、术前、术中和术后因素以及患者结局。数据分析采用SPSS 25版，运用描述性统计和多变量逻辑回归来确定结局的独立预测因素。主要结局指标是出院时的格拉斯哥预后量表（GOS）。
该研究纳入了71例破裂颅内动脉瘤患者，其中62例患者的63个动脉瘤进行了夹闭术。未观察到性别偏好。动脉瘤主要位于大脑前循环（98.6%），其中60.6%位于前交通动脉。75.76%的病例动脉瘤大小小于10毫米。83.9%的患者获得了良好结局，而16.10%的患者结局不佳。不良结局与格拉斯哥昏迷量表（GCS）评估的神经功能恶化分级相关。迟发性血管痉挛和偏瘫的发生显示出很强的预测价值。
该研究显示出可接受的死亡率和良好结局。破裂性脑动脉瘤患者的结局主要受不可改变的因素影响，如入院时的GCS和神经功能缺损。与颅内动脉瘤患者常用的WFNS和Hunt-Hess量表相比，GCS对结局具有更高的预测价值。
