Treatment of ruptured intracranial aneurysms: report from a low-volume center.
BACKGROUND
The aim of this retrospective analysis was to present our experience and results in treating subarachnoid hemorrhage due to ruptured intracranial aneurysms at a neurosurgical department with a small annual number of cases (i.e. a low-volume center) and to discover which factors could influence treatment and reliably predict the outcome of hemorrhage.


METHODS
All patients with aneurysmal subarachnoid hemorrhage treated at our department between 1973 and 2003 were retrospectively analyzed. We performed 293 operations and 21 endovascular procedures. In the majority of patients we excluded the aneurysm from circulation by placing a clip on the aneurysmal neck. Relevant data were obtained on patients' performance, imaging studies, treatment and outcome.


RESULTS
According to the Hunt & Hess grade, the majority of patients were in groups 1 or 2. Perioperative mortality was 3%. Postoperative mortality due to complications related to subarachnoid hemorrhage was 10%. Vasospasm was detected in 18% of patients and was a direct cause of death in 5%. The outcome was good in 68% (grades 4 or 5 on the Glasgow outcome scale). In multivariate analysis, the Hunt & Hess grade, age and clinical vasospasm all had important predictive value for the outcome.


CONCLUSIONS
The results of treatment in our series of patients fall within reported norms and are comparable to results from other low-volume centers. For successful treatment of aneurysmal subarachnoid hemorrhage, fast diagnosis, correct surgical or endovascular treatment and proper intensive pre- and postoperative care are of utmost importance.
Bunc
Gorazd
G
Department of Neurosurgery, Maribor Teaching Hospital, Ljubljanska ulica 5, 2000 Maribor, Slovenia. gorazd.bunc@sb-mb.si
Ravnik
Janez
J
Seruga
Tomaz
T
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012421:Rupture / Q000401:mortality; D017524:Slovenia / Q000453:epidemiology; D013345:Subarachnoid Hemorrhage / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality*