EVALUATION OF ANEURYSM SURGERY OF ANTERIOR CEREBRAL CIRCULATION: CLINICAL PRESENTATION, RADIOLOGICAL ASSESSMENT, OPERATIVE FACTORS AND OVERALL OUTCOME

Abstract

This is a series of 40 patients admitted in The Departments of Neurosurgery at

UIC and Suez Canal University at lsmailia, in the periOd from January 1997 to December

1998 tOr surgical clipping of their intracranial aneurysms. Outcome was assessed using the Glasgow Outcome Scale at one and six months from day of hemorrhage. Data analysis demonstrated the following: I) 25 •patients (60%) were admitted after aneurysmal rupture, while the remaining 40% had intact aneurysms. 2) 55% of patients were normal at one month follow-up or had been minimally or moderately disabled. 3) This percentage improved to 77.7% after six months follow-up. 4) Mortality was 14.8% after 6 •months. 5) Prognostic factors for poor outcome at one month follow were: Hunt and Hess, and Fisher grading at admission, presentation with motor deficit, tight brain on exploration, difficult dissection of the aneurysm and CSF cisterns, intraoperative aneurysmal leak or rupture, need for major brain resection during surgery, inappropriate clip placement, vasospasm, and postoperative intracerebral hemorrhage. However, six months follow-up showed that Fisher grading, motor deficit at presentation, and post­ operative intracerebral hematoma were the only predictor variables for outcome. The overall management results clearly indicate that there are many variables that play significant role in determining the final outcome. More attention and meticulous manipulation should be given to all factors that may improve the overall outcome. This opportunity for improvement is not limited to_ the pre-, intra-, and immediate post­ operative periods, but . is also extended to the period of rehabilitation. Physical, occupational, speech, and psychotherapy might have considerable value in changing the outcome. Although, this study does not have data to support this, the improvement of outcome from one to six months follow-up and the loss of significance of studied variable to predict the late outcome may suggest the role of rehabilitation. On the other hand, the study is limited by its design and the small number of subjects. However, only a well-designed, prospective, randomized study may clarity the value of specific variables in predicting the outcome. It is also likely that there will be continued developments in management of cerebral aneurysm including endovascular therapy. The indications and benefits of Surgical and/or endovascular occlusion of aneurysms has to be considered together in future studies.