2년간 전체 뇌동맥류 파열 환자의 치료 성적

Abstract

The purpose of this study was to assess the overall management outcome of patients with ruptured intracranial aneurysm during a 2-year period from 1991 to 1993. Among the 219 consecutive cases with ruptured intracranial aneurysm, 189 patients underwent surgery for ruptured aneurysm but 30 patients could not have surgery due to reasons such as being in a moribund state or refusal of surgery. Follow-up evaluation, performed at least 3 months after discharge, revealed 160 patients(73.0%) of good, 17(7.8%) of fair, 23(10.5%) of poor, and 19(8.7%) of dead outcome. Initial clinical condition on admission(Hunt and Hess Grade), amount and distribution of hemorrhage on brain computerized tomography(Fisher Grade), and presence of delayed ischemic deficits were closely related to the outcome. Patients with middle cerebral artery aneurysm showed a worse outcome than those with aneurysms at other locations. Patients admitted within 24 hours after rupture of the aneurysm or with early surgical treatment(within 3 days)also showed a worse outcome. The main causes of unfavorable outcome(poor or dead outcome)were initial hemorrhagic insult, delayed ischemic deficits, and rebleeding. In this study, favorable surgical outcome enabled a better overall outcome as compared to other reports. To improve overall management outcome, intensive management should be started from the very beginning of the patient's arrival. In addition, the elderly and patients with a poor grade should be managed aggressively and cautiously.