A Recent 6-year Review of Good Grade Patients with Aneurysm Surgery : Surgery Outcome and its Contributing Factors

Kang, Sung Don

Abstract

It became possible for a beginner of aneurysm surgery to shorten the stabilization period of surgical technique recently with several advances in the management of subarachnoid hemorrhage, such as early surgery, aggressive critical care, anesthetic technique, calcium channel blockers, and hypervolemia. The present study was conducted to determine whether surgical outcome actually changed over the years and what factors contributed to these changes. 219 good grade(Hunt-Hess grade I to III) patients with ruptured intracranial aneurysms operated by the same operator within 3 days after the attack from 190 to 995 were selected to reduce selection bias. All possible clinical and radiological factors for surgical outcome were analyzed to find significant factors, and then distributions of each significant factors were examined between 2 treatment periods(1990 to 1993 vs 1994 to 1995). Surgical outcome began to improve significantly since 1994(1990-93 vs 1994-95, p<0.005):75.0%(12/16) in 1990, 80.8%(21/26) in 1991, 77.4%(24/31) in 1992, 78.4%(40/51) in 1993, 87.8%(36/41) in 1994, 96.3%(52/54) in 1995 experienced good outcome. The decrease of postoperative surgical complications was the only factor influencing an increase of good outcome between 2 treatment periods. The distribution and characteristics of other possible biological significant factors for outcome were not different statistically. Improvement of surgery outcome by a vascular neurosurgeon depends on the number of experienced cases, and case qualities such as distributions of aneurysm size, location, and clinical grade etc. These results suggest that surgical technique importantly affects the change of surgical outcome, and consequently, considering usual level of surgical technique, more careful approach with assistance of an experienced vascular neurosurgeon than surgery by oneself will be necessary for first 4 to 5 years of aneurysm surgery.