Outcomes of surgical treatment for ruptured pericallosal artery aneurysms

Abstract

The study objectiveis to assess short-term outcomes of surgical treatment in patients with ruptured pericallosal artery aneurysms (PCAA) and to identify factors affecting treatment outcomes.Materials and methods.Patients with ruptured PCAA (n = 61) were admitted to the Department of Emergency Neurosurgery at the N. V. Sklifosovsky Research Institute for Emergency Medicine for examination and surgical treatment between 01.01.1992 and 31.12.2015.Results.At the moment of discharge, 33 (54.1 %) patients demonstrated good recovery (Glasgow Outcome Scale (GOS) of 5), 9 (14.7 %) patients had moderate disability (GOS 4), 6 (9.9 %) patients had severe disability (GOS 3), and 13 (21.3 %) patients died (GOS of 1). An outcome was rated as favorable if the GOS was 4 or 5 and unfavorable if the GOS was 1–3. The following risk factors were found to be significant for unfavorable surgical outcome: Hunt and Hess grade 4 and 5, presence of intracerebral hematoma and its volume over 20 cm3, recurrent aneurysm rupture, pronounced angiospasm and intraventricular hemorrhage, early surgery (within 1–3 days). The patient»s age and the volume of intraventricular hemorrhage had no impact on the surgical outcome.Conclusion.The choice of an optimal surgery time should be based on the assessment of hemorrhage severity upon admission. Early surgery is recommended for all patients with Hunt and Hess grade I–II, whereas in patients with Hunt and Hess grade V, the intervention should be postponed until the condition is stabilized, unless the severity is associated with a dislocation syndrome due to intracerebral hematoma or occlusive hydrocephalus. In patients with Hunt and Hess grade III–IV, the decision on surgery time should be made for each individual patient according to existing risk factors.