Causes of morbidity and mortality after ruptured aneurysm surgery in a series of 230 patients. The importance of control angiography.
OBJECTIVE
The purpose of this study was to determine the causes of morbidity and mortality after surgery for ruptured aneurysms.


METHODS
Two hundred thirty consecutive patients were studied. Initial hemorrhage volume and vasospasm were evaluated preoperatively with CT, transcranial Doppler ultrasonography, and angiography. Nimodipine infusion was started before surgery. Preoperative clinical status was evaluated according to Hunt and Hess grading criteria. Surgery was performed early in 186 patients (81%). Control angiography, transcranial Doppler ultrasonography, and CT were performed routinely after surgery. Hypodense areas revealed by control CT were related to intracerebral initial hematoma, vasospasm, postoperative thrombosis, or spatula hyperpressure.


RESULTS
Clinical outcome was excellent or good (Glasgow Outcome Scale [GOS] scores of 1 or 2) in 176 patients (77%), 17 (7%) were disabled (GOS score of 3), and 37 (16%) were vegetative or dead. In patients in good condition (grades I to III) preoperatively (n = 200), 38 had an unfavorable outcome (GOS score of 2, 3, 4, or 5). The major cause of complication was postoperative thrombosis (42%). In patients in poor condition (grade IV or V) (n = 30), 27 had an unfavorable outcome. The major cause of complication was initial bleeding (66%). Vasospasm was responsible for delayed ischemic deficit in 9 patients (3.9% of the total population).


CONCLUSIONS
Systematic angiography remains by far the best means for determining the cause of a poor postoperative course.
Proust
F
F
Department of Neurosurgery, Centre Hospitalier Universitaire, Rouen, France.
Hannequin
D
D
Langlois
O
O
Freger
P
P
Creissard
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D002545:Brain Ischemia / Q000209:etiology; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000601:surgery; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000209:etiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology; D007427:Intracranial Pressure; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009553:Nimodipine / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000601:surgery; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
D009553:Nimodipine