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The Analysis of Prognostic Factors Impacting the Surgery of Ruptured Intracranial Aneurysms with Intracranial Hematoma

Author: ZhaoDaWei
Tutor: GaoWenSheng
School: Hebei Medical University
Course: Surgery
Keywords: ruptured intracranial aneurysm intracranial hematoma craniotomy prognosis
CLC: R651.1
Type: Master's thesis
Year: 2012
Downloads: 53
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Abstract


Objective: With the retrospective analysis of the clinical and imagingcharacteristics about surgical treatments of intracranial ruptured aneurysmsassociated with intracranial hematoma, to analyze their database, discuss therelevant factors affecting the prognosis and provide help for the treatment infuture.Methods: Analysis clinical database of49cases diagnosed rupturedintracranial aneurysms associated with intracranial hematoma after surgicaltreatment from March2007to December2011, admitted to Neurosurgery,Second Hospital of Hebei Medical University.Inclusion criteria:All patients diagnosed intracranial hematoma with head CT, diagnosedruptured intracranial aneurysms with preoperative3D-CTA or DSA onoperation, and diagnosed intracranial aneurysms with intracranial hematomaduring the exploratory operation.Exclusion criteria:Exclude the cases subarachnoid hemorrhage or intracranial hematomacaused by trauma, exclude the cases that intracranial aneurysm was not foundwith the3D-CTA or DSA, exclude the cases diagnosed other cerebrovasculardiseases with3D-CTA or DSA, such as arteriovenous malformations,moyamoya disease, exclude the cases treated conservatively, exclude the casestreated by interventional embolization and referral treatment, exclude thecases hematoma formation after surgery, and exclude the cases that theaneurysm has not been fully clipping, only wrapped surgery.Outcome:Neurological function in patients with Glasgow Outcome Rating Scale(GOS) score. The GOC score of1,2and3in patients were identified as poor prognosis, the GOC score of4,5in patients were identified as good prognosis.The final GOS score was decided by the follow-up in0.5-3years.With the help of SPSS19.0statistical software, using logistic-regressionstatistical methods, the possible prognostic factors such as patient’s age,awareness, timing of surgery, aneurysm diameter size were discussed withunivariate analysis and multivariate analysis in order to determine the mostvaluable variable factors affecting the prognosis.Results: The possible factors affecting the prognosis such as the patient’sage, preoperative DSA, hematoma breaking into the ventricle in preoperativeCT, the previous history of hypertension, the size of the aneurysms, history ofsmoking, preoperative GCS, the site of the aneurysms, preoperative awareness,timing of surgery, the volume of hematoma cleared, postoperative cerebralinfarction were discussed with the univariate analysis.The results showed thatthe patient’s age, the size of the aneurysms, the site of the aneurysms andtiming of surgery were not statistically significance in affecting prognosis.The factors preoperative DSA, hematoma breaking into the ventricle inpreoperative CT, the previous history of hypertension, history of smoking,preoperative GCS, preoperative awareness, the volume of hematoma cleared,postoperative cerebral infarction were discussed with the multivariatestepwise analysis. The results show that hematoma breaking into the ventriclein preoperative CT and preoperative GCS are the independent risk factorsaffecting prognosis and it is statistically significant.Conclusion: In the surgical treatments of intracranial ruptured aneurysmsassociated with intracranial hematoma by craniotomy, the cases thathematoma breaking into the ventricle in preoperative CT have poor prognosis,the cases of lower preoperative GCS have poor prognosis.

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