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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Analysis of morbidity and mortality after anterior circulation aneurysm surgery at the University in Wroclaw from 2004–2007

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  • M. Kozba-Gosztyla - Depatrment of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
  • W. Jarmundowicz - Depatrment of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
  • B. Czapiga - Depatrment of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.11.07

doi: 10.3205/11dgnc084, urn:nbn:de:0183-11dgnc0840

Published: April 28, 2011

© 2011 Kozba-Gosztyla et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The aim of this study was to assess the complications, morbidity and mortality after surgery of aneurysms located in the anterior part of the circle of Willis.

Methods: We retrospectively analyzed the results of surgical treatment in 46 patients with unruptured aneurysms and 262 patients with ruptured aneurysms. The patients’ condition at discharge was evaluated with the GOS. Favorable outcome was determined as 4-5 GOS points, unfavorable as 1-3 GOS points.

Results: In the postoperative course, 26% of patients had cerebral edema (77.8% of these patients were in poor neurological condition on admission). Delayed vasospasm occurred in 25% of patients, mainly on the 3rd-5th postoperative day. Hydrocephalus occurred in 18.8% of patients but only 5.5% required a ventriculoperitoneal shunt. Postoperative hematoma occurred in 4.2% of patients. FND (focal neurological deficits) could only be evaluated in conscious patients (Hunt-Hess grade 0-III). In this group, 18% of patients had new FND at discharge, 5.2% died. There was a statistically lower incidence of cerebral edema (62.8% vs. 5.2%; p < 0.001), delayed vasospasm (40.5% vs. 17.1%; p = 0.00001), hydrocephalus (29.2% vs. 13%; p < 0.001), postoperative hematoma (8% vs. 2%; p = 0.01) in the group of patients with a favorable outcome compared to patients with an unfavorable outcome. Multiple regression analysis revealed that among the postoperative factors, only delayed vasospasm affects outcome. Among the patients operated on for cerebral aneurysms, 59 died, which equates to a mortality of 19.7%. In the group of the patients who died, 81% were in a severely deteriorated neurological state on admision (Hunt-Hess IV-V). Logistic regression analysis revealed that the factors influencing the risk of death are: neurological state on admission, age, cerebral edema in the postoperative course. In the group of the patients with unruptured cerebral aneurysms, we evaluated the absolute risk of postoperative complications, which were: mortality 2.1%, morbidity 8.7%.

Conclusions: Poor outcome and mortality strongly depend on the neurological state on admission, age, cerebral edema and delayed vasospasm in the postoperative course. The clipping of an unruptured aneurysm is safe, with a relatively low risk of mortality and mortality (10.8%).