Factors Affecting on the Prognosis in Multiple Intracranial Aneurysms

Öz

Background: With improvements in diagnostic methods, the incidence of multiple intracranial aneurysms has increased up to 35%. Factors influential on outcome in multiple intracranial aneurysms are still debatable. We aimed to determine risk factors related to multiple intracranial aneurysms in patients admitted with subarachnoid hemorrhage caused by a ruptured intracranial aneurysm.
Material and Methods: This retrospective study was performed on 105 aneurysms of 48 patients diagnosed with multiple aneurysms using charts, records, and film archives among 250 patients admitted to İstanbul Haydarpaşa Numune Training and Research Hospital between January 2003-December 2009 who were examined and treated for subarachnoid hemorrhage. Age, gender, medical history, admission/surgery times, clinical features determined on neurological examination at admission (WFNS Score), amount of blood measured on cranial computed tomographic images (Fisher Score), number of aneurysms and systems to which they belonged, complications, and Glasgow outcome scale indicating the morbidity and mortality were recorded.
Results: The mean age was 52.75±14.02(4-90) years. The female/male ratio was 2.2. Most common clinical features were headache (83.7%), and hypertension (56.3%). The most common location was the middle cerebral artery, and aneurysm size was 2-6 mm (66.7%). The most common intervention was an early clipping of as many aneurysms as possible in one session (84.7%). Vasospasm and hydrocephalus were the most common complications (31.1%, 16.6%, respectively). No difference was present between early and late interventions regarding mortality. Glasgow outcome Scale was negatively correlated with Fisher score (r=-0.306), but not with WFNS score.
Conclusions: Age, amount of cisternal blood preoperatively, and postoperative vasospasm are risk factors for mortality, but not hypertension and postoperative hydrocephalus. WFNS Scoring system is not a reliable mortality predictor.

Key Words: Multiple intracranial aneurysms, Fisher score, Glasgow outcome scale, Subarachnoid hemorrhage, WFNS Score

Anahtar Kelimeler

• Multiple intracranial aneurysms
• Fisher score
• Glasgow outcome scale

Çoklu İntrakraniyal Anevrizmalarda Prognozda Etkili Faktörler

Öz

Amaç: Tanı yöntemlerindeki gelişmelerin sonucunda, multipl intrakraniyal anevrizma insidansı %35'e kadar yükselmiştir. Multipl intrakraniyal anevrizmalarda prognoz üzerinde etkili olan faktörler halen tartışmalıdır. Bu çalışmada, rüptüre olmuş intrakraniyal anevrizmanın neden olduğu subaraknoid kanama ile başvuran hastalarda MİA prognozu ile ilişkili faktörleri belirlemeyi amaçladık.
Materyal ve Metod: Bu retrospektif çalışma, Ocak 2003-Aralık 2009 tarihleri arasında İstanbul Haydarpaşa Numune Eğitim ve Araştırma Hastanesi’nde subaraknoid kanama nedeni ve anevrizma tanısı ile tetkik ve tedavi edilen 250 olgu arasında hasta çizelgeleri, kayıtları ve film arşivleri değerlendirilerek multipl anevrizma kriterlerine uyan 48 olgunun 105 anevrizması üzerinde gerçekleştirildi. Yaş, cinsiyet, tıbbi öykü, başvuru / cerrahi süreleri, başvurudaki nörolojik muayene bulgu değerlendirmesindeki özellikler (WFNS skoru), bilgisayarlı beyin tomografi görüntülerde ölçülen kan miktarı (Fisher Skoru), anevrizma sayısı ve ait oldukları sistemler, komplikasyonlar, morbidite ve mortaliteyi gösteren Glasgow sonuç skalası kaydedildi.
Bulgular: Yaş ortalaması 52,75 ± 14,02 (4-90) yıldı. Kadın / erkek oranı 2.2 idi. En sık görülen klinik özellikler baş ağrısı (% 83.7) ve hipertansiyon (% 56.3) olarak bulundu. En sık yerleşim yeri orta serebral arterdi ve anevrizma boyutu 2-6 mm (% 66.7) idi. En sık yapılan girişim tek seansta mümkün olduğunca çok anevrizmanın erken kliplenmesiydi (% 84.7). Vazospazm ve hidrosefali en sık görülen komplikasyonlardı (sırasıyla % 31.1 ve % 16.6). Erken ve geç girişim zamanları arasında mortalite açısından fark bulunmadı. Glasgow sonuç skalası skoru ile Fisher skorunun negatif korelasyonu olduğu bulundu (r = -0.306), ancak WFNS evresi ile korelasyon mevcut değildi.
Sonuç: Yaş, preoperatif sisternal kan miktarı ve postoperatif vazospazm mortalite için risk faktörleri olarak bulundu. Ancak hipertansiyon ve postoperatif hidrosefali risk faktörü değildi. WFNS skorlama sisteminin güvenilir bir mortalite belirleyicisi olmadığı sonucuna varıldı.

Anahtar Kelimeler: Çoklu intrakraniyal anevrizma, Fisher skoru, Glasgow sonuç skala, Subaraknoid kanama, WFNS evresi

Anahtar Kelimeler

• subaraknoid kanama
• çoklu intrakraniyal anevrizma
• WFNS skoru
• Fisher skoru
• GOS skoru

Kaynakça

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