Surgical treatment of ruptured middle cerebral artery aneurysms: clinical outcomes and prognostic factors

Abstract

Objective To investigate the risk factors for clinical poor outcome after microsurgical treatment of ruptured middle cerebral artery aneurysms (MCAA). Methods The patients with ruptured MCAA treated with microsurgery were enrolled retrospectively. The data of demography, medical history, Hunt-Hess grade, imaging characteristics, surgery-related factors, and postoperative complications were collected. Glasgow Outcome Scale (GOS) was used to assess the outcomes. GOS 4-5 was defined as a good outcome and 1-3 was defined as a poor outcome. Results A total of 44 patients with ruptured MCAA were enrolled, including 26 (59.1%) females and 18 (40.9%) males, aged 36-75 years old (mean 58.5 years). The aneurysms were clipped in 42 cases (95.5%) and wrapped in 2 cases (4.5%). They were followed up for 3-6 months, 33 (75.0%) had good outcome and 11 (25.0%) had poor outcome. Univariate analysis showed that there were significant differences in the proportions of Hunt-Hess grade, midline shift degree, hematoma volume, intraoperative rupture, decompressive craniectomy, and postoperative pulmonary infection between the good outcome group and the poor outcome group. Multivariate logistic regression analysis showed that Hunt-Hess grade Ⅳ-Ⅴ (odds ratio [OR] 20.885, 95% confidence interval [CI] 1.342-38.696; P=0.001), intraoperative aneurysm rupture (OR 18.906, 95% CI 2.918-20.915; P=0.011), and complicated with pulmonary infection (OR 38.865, 95% CI 18.718-40.509; P=0.001) were the independent risk factors for poor outcomes. Conclusion The high Hunt-Hess grade, intraoperative aneurysm rupture, and complicated with pulmonary infection after surgery are the independent risk factors for poor outcomes after microsurgical treatment in patients with ruptured MCAA. Key words: Intracranial Aneurysm; Aneurysm, Ruptured; Middle Cerebral Artery; Subarachnoid Hemorrhage; Hematoma; Neurosurgical Procedures; Treatment Outcome