Intraoperative events affecting the outcome in Early aneurysm surgery

Abstract

Introduction : There have been numerous outcome-estimating scales for aneurysm surgery (preoperative clinical and Fisher grading scale), however, different outcomes were sometimes reported despite the same surgeons' hands. Authors investigated several intraoperative events which could affect the final outcome and tried to utilize more graded and objective outcome prediction. Methods : During the last 3 years, authors studied 54 patients who had undertaken early aneurysm surgery in which intraoperative videograms available. The authors compared the degree of brain edema and atherosclerosis, premature rupture, and feasibility of clipping with the Glasgow outcome scale in postoperative patients. Results : Brain edema was controlled by hyperosmolar solution in 41 patients, by ventricular puncture in 9, and by cortical resection in 4. Atherosclerosis was seen in 19 patients. Among them, atherosclerotic vessels including both parent artery and neck was found in 7. Premature rupture was seen in 6 patients. Beside 2 patients with rupture in the predissection period, 4 underwent suction decompression and final clip placement without any major difficulty. Definite clipping without temporary one was possible in 45 patients, whereas clip revision or repetitive clipping in 9 patients. Conclusions : Poor prognoses (GOS 1-3) were shown in patients with severe brain edema in which cortical resection was needed, atherosclerosis in aneurysmal neck portion, and/or wide neck in which clipping compromised parent artery. However, premature rupture, clipping more than 2 clips, and/or repetitive clipping did not affect the outcome.