Lin C L, Kwan A L, Howng S L
Department of Neurosurgery, Kaohsiung Medical College Hospital, Taiwan, Republic of China.
Kaohsiung J Med Sci. 1998 Sep;14(9):561-8.
During a 6-year period, 65 consecutive patients who had undergone anterior communicating artery aneurysmal surgery were reviewed at a follow-up examination from 6 to 78 months (mean 35 months) after operation. On admission 69% of cases had a good Hunt and Hess scale (grades I to II) and 31% a poor grade (grades III to V). The degree of subarachnoid hemorrhage (SAH) was determined by Fisher's grade. Sixteen (25%) patients were classified in grades I and II. Forty-six percent of cases had pre-existing hypertension. Early surgery (within the first three days after the bleeding) was performed in 17% of cases. Intraoperative rupture of aneurysm occurred in six (9.2%) patients. Symptomatic cerebral vasospasm was diagnosed in 14 (22%) cases, but only 8 (12%) had evidence of low density on the computerized tomographic scan. Hydrocephalus developed in 16 (25%) cases and 10 needed ventriculoperitoneal shunting. The outcome was determined using the activity of daily life. Sixty-five percent of the patients made a good recovery and 13.8% died. The significant poor prognostic factors included a poor pre-operative grade of the Hunt and Hess scale, the presence of symptomatic cerebral vasospasm, and the Fisher's SAH grade of greater than II. Other factors which apparently were not related to the outcome included age, sex, timing of surgery, history of hypertension, intraoperative rupture, and the development of hydrocephalus.
在6年期间，对连续65例接受前交通动脉瘤手术的患者进行了术后6至78个月（平均35个月）的随访检查。入院时，69%的病例Hunt和Hess分级良好（I至II级），31%分级较差（III至V级）。蛛网膜下腔出血（SAH）的程度由Fisher分级确定。16例（25%）患者为I级和II级。46%的病例有高血压病史。17%的病例进行了早期手术（出血后三天内）。6例（9.2%）患者术中动脉瘤破裂。14例（22%）诊断为有症状性脑血管痉挛，但计算机断层扫描显示低密度的只有8例（12%）。16例（25%）发生脑积水，10例需要行脑室腹腔分流术。根据日常生活活动能力确定预后。65%的患者恢复良好，13.8%死亡。显著的不良预后因素包括术前Hunt和Hess分级差、有症状性脑血管痉挛以及Fisher SAH分级大于II级。其他明显与预后无关的因素包括年龄、性别、手术时机、高血压病史、术中破裂和脑积水的发生。
