Surgical Outcome of Anterior Communicating Artery Aneurysms

在六年間共有65位病人接受手術治療前交通動脈瘤。追蹤時間從術後6個月至78個月(平均35個月)。入院時69%的病人其Hunt and Hess等級為第一級或第二級，而蜘蛛膜下出血的Fisher等級25%為第一級或第二級。46%的病人有高血壓的病史。早期手術(出血後三天內)占17%。術中動脈瘤破裂者有六位，占9.2%。有症狀的血管痙攣者有14位(22%)，但只有8位在腦部電腦斷層上有低密度區的發現。有16位病人發生水腦症，其中10位需放置腦室腹腔流管。病人的預後以日常生活活動度(ADL)來評估，65%的病人回復到ADL第一級或第二級，13.8%的病人死亡。與不良預後有關的因子為：較差的Hunt and Hess等級(第三至第五級)，有症狀的血管痙攣及Fisher第三級及第四級。其他與預後無關的因子為：年紀、性別、開刀時機、高血壓病史、術中動脈瘤破裂及水腦症。

關鍵字

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並列摘要

During a 6-year period, 65 consecutive patients who had undergone anterior communicating artery aneurismal surgery were reviewed at a follow-up examination form 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 (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%) chses, but only 8 (12%) had evidence of low density on the computerized tomographic scan. 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.

並列關鍵字

anterior communicating artery ； intracranial aneursm ； surgical outcome

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Surgical Outcome of Anterior Communicating Artery Aneurysms

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