[Early and urgent (micro)surgery of single and multiple intracranial aneurysms of anterior and posterior circulation and total mortality rate after operative and conservative treatment].
BACKGROUND
The early and urgent ruptured cerebral aneurysm microsurgery principle is being presented. In Bosnia, this principle was pioneered by author (KD) as a part of aneurysmal subarachnoid hemorrhage treatment. The main goal of this strategy was to prevent the rehemorrhage which mortality rate is up to 80%.


RESULTS
A one-year (April 2003-April 2004) prospective study of 24 no selected patients with 33 anterior and posterior circulation aneurysms was conducted. Patients were operated on early (42%) and urgently (58%) regardless of their Hunt-Hess grade, age and vasospasm, but also localization, size and number of aneurysms. Twenty four ruptured aneurysms underwent the clip occlusion (100%). A total of 30 (91%) aneurysms were clipped with only one intraoperative rupture (3.3%). The overall mortality rate for anterior circulation aneurysms regardless of HH grade was 12.5%. All patients with HH gr I and II had excellent outcome (100%). Mortality rate of patients with HH gr III harboring anterior circulation aneurysms was 7.6%. The patients with HH gr IV and V died in 50% of cases despite surgical treatment. Multiple aneurysms increased mortality rate of operated patients.


CONCLUSIONS
Ruptured aneurysm should be occluded immediately although the operative outcome of early and urgent surgery is worse than late surgery. Especially urgent surgery has bad outcome because it is mainly performed during cerebral vasospasm. But the overall outcome is the worst after utilizing the principle of late surgery. In one month period of time, no operated patients have 50% of chance to experience rehemorrhage (80% mortality rate), 36% of chance to develop symptomatic vasospasm with 7-15% mortality, and 20-50% possibility of occurring the hydrocephalus. According to recent studies, the overall mortality rate of untreated patients with aneurysmal SAH is over 50%. Mortality of surgically and conservatively treated patients is 20-30%. The survival rate of patients with HH gr IV and V who are exclusively treated by conservative therapy is only 10%.


CONCLUSIONS
Early and urgent aneurysm microsurgery resulted in outcome improvement of operated patients up to 30% compared with expected outcome of patients without surgery. The justification for early and urgent aneurysm surgery was found in almost all patient groups, HH gr I&II patients had benefit in 23-30% of cases, HH gr IV&V had benefit in 20-40% and HH gr III with anterior circulation aneurysms had benefit in 15-20% of cases.
Dizdarević
Kemal
K
Klinika za neurohirurgiju, Klinicki centar Univerziteta u Sarajevu. KEMALDIZ@BIH.NET.BA
Iblizović
Nermina
N
Kadić
Naim
N
D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000601:surgery; D015996:Survival Rate