Neurological and psychosocial outcome after subarachnoid haemorrhage, and the hunt and hess scale as a predictor of clinical outcome

In a retrospective study, the outcome of 87 patients with ruptured intracranial aneurysm was assessed. Follow-up included neurological examination, grading of the Glasgow Outcome Scale (GOS) of each patient, and answering a psycho-social questionnaire. This questionnaire was answered by the patients themselves or by a relative when the patient was not able to answer. The follow-up was performed more than 12 months after the occurrence of subarachnoid hemorrhage (SAH) in each patient. The psycho-social questionnaire pertained to the degree of independence in everyday activities, household management, stress endurance, memory and concentration, social and leisure activities, social contacts, occupational status, and marital relationships. By summarizing the results of these domains, the quality of life was then determined using the method described by McKenna et al. Neurological deficits in the form of an incomplete paresis of the third cranial nerve and subjective reduction of memory and concentration were identified in 3.5 % and 34.5-39 % of the patients, respectively. Of the 87 study participants, 58.2 % were fully independent, 22.4 % were able to live at home with the support of their relatives, and 5 patients were fully dependent. The occupational status of 21 patients who were fully employed before SAH was unaffected, whereas 3 patients were placed in positions with less responsibility, and 21 patients were either unable to continue working, unemployed, or retired. The quality of life was not reduced in 57.2 %, while a mild reduction in the quality of life was reported by 23.8 % and a severe reduction by 19.0 % of the participants. The ability of the initial Hunt and Hess grade, the initial Fisher grade, the extent of neurological deficits, and the occupational status after SAH to predict the patient's outcome was also evaluated. For statistical analysis, the Kendall-Tau-b-test for non-parametric correlations was applied. Significant correlations were found between the initial Hunt and Hess grade and the initial Fisher grade, between neurological deficits and GOS, between quality of life and occupational outcome, as well as between the GOS and quality of life assessment, but not between initial Hunt and Hess grade and GOS or quality of life, between neurological deficits and quality of life, between initial Hunt and Hess grade and occupational outcome, between initial Fisher grade and occupational outcome, and also not between initial Fisher grade and GOS or quality of life. Our results suggest that neither the initial Hunt & Hess grade nor the initial Fisher grade are suitable parameters for predicting the outcome of patients with ruptured intracranial aneurysms. The fact that GOS and quality of life correlated significantly confirms the use of GOS as a simple method for evaluating patient outcome, although it is not a grading system for evaluating functional disorders such as memory or subtle cognitive impairments.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

Does intraoperative aneurysm rupture influence outcome? Analysis of 169 patients

OBJECTIVES: The aim of this study was to evaluate the prognostic value of intraoperative aneurysm rupture (IAR) in patients with subarachnoid hemorrhage (SAH) undergoing surgery for cerebral aneurysms. PATIENTS AND METHODS: Between July 1997 and April 2000, 292 consecutive patients were admitted to our institution with SAH due to ruptured intracranial aneurysms. Of these, 169 patients were treated surgically according to standard microsurgical procedures and were included in this study. Mean age was 47 years. Initial clinical state was graded according to the classification of Hunt and Hess (HH). Outcome was classified according to the Glasgow Outcome Scale as favorable (grades IV and V) and unfavorable (grades I-III). Outcome of patients with intraoperative ruptured and non-ruptured aneurysms was analyzed in correlation to the preoperative clinical state and with respect to the time of surgery and to aneurysm localization. RESULTS: Different rupture rates were observed with respect to the localization of the aneurysm: anterior circulation (n=69) 39.1%, middle cerebral artery (n=46) 34.8%, internal carotid artery (n=48) 31.2%, and posterior circulation (n=6) 16.7%. Patients with HH-grades I-III showed a favorable outcome in 72.2% (61 of 84 patients) without intraoperative rupture and in 71.7% (33 of 46 patients) with intraoperative aneurysm rupture. The corresponding values for patients with HH-grades IV/V were: favorable outcome in 34.6% (9 of 26 patients) and 23.1% (3 of 13 patients), respectively. Poor initial clinical condition (HH IV and V) as well as the initial Fisher grades III and IV were strongly associated with poor clinical outcome. CONCLUSIONS: Intraoperative aneurysm rupture has no impact on the outcome, neither in patients with good initial condition nor for poor grades patients.     

Predictors for cognitive impairment one year after surgery for aneurysmal subarachnoid hemorrhage

OBJECTIVE: To assess predictors for cognitive impairment one year after spontaneous subarachnoid hemorrhage (SAH). Evaluated predictors were the total amount of cisternal blood seen on computed tomography (CT) in the acute phase as measured by the Fisher grade, neurological grade at admission classified according to the Hunt and Hess scale, aneurysm site and patient's age, gender and education level. METHOD: 44 patients were operated by surgical clipping within 72 hours after CT verified aneurysmal SAH. After twelve months the remaining 42 patients were assessed by neuropsychological test, Beck Depression Inventory (BDI), the Glasgow Outcome Scale (GOS) and CT. Multiple regression analysis was conducted where predictor variables were independent factors and a global impairment index calculated for each patient was the dependent factor. RESULTS: The Fisher grade was the only independent predictor for neuropsychological impairment. Most patients had good neurological outcome as measured by the GOS and at the same time suffered from some degree of cognitive impairment at follow-up. Individual analysis of cognitive test scores showed mild to moderate dysfunction across multiple cognitive domains. Most frequent impairments were found in domains of memory, executive function and speed of information processing. Age below 50 years was associated with relatively better outcome. CONCLUSION: The severity of cognitive impairment one year post SAH is predicted by the volume of blood in the subarachnoid space as measured by the Fisher score.     

Outcomes of early physiotherapy in patients with cerebral aneurysms treated by surgical clipping or endovascular embolization

Early physiotherapy was given to 124 patients with ruptured or unruptured cerebral aneurysms who were treated by surgical clipping or endovascular embolization.Patients were divided into four groups according to their Hunt and Hess grade at admission and aneurysm treatment modality: Group 1,Hunt and Hess grade≤II and surgical clipping;Group 2,Hunt and Hess grade≤II and endovascular embolization;Group 3,Hunt and Hess grade≥III and surgical clipping;Group 4,Hunt and Hess grade≥III and endovascular embolization.Level of consciousness was evaluated using the Glasgow Coma Scale,functional status using the Glasgow Outcome Scale,level of the mobility using the Mobility Scale for acute stroke patients,and independence in activities of daily living using the Barthel Index.After early physiotherapy,the level of consciousness and functional status improved significantly in Groups 1,3,and 4;mobility improved significantly in all groups;and independence in activities of daily living improved significantly in Groups 1 and 3.At discharge, Groups 1 and 2 had better functional status than Groups 3 and 4.Level of consciousness,functional status,mobility and independence in activities of daily living improved after early physiotherapy. These findings suggest that early physiotherapy improved the prognosis of patients with cerebral aneurysms who were treated by surgical clipping or endovascular embolization.Patients with a worse clinical status at presentation had a poorer functional status at discharge.The outcome of physiotherapy was not affected by whether surgical clipping or endovascular embolization was chosen for treatment of the aneurysm.     

Patients with Supratentorial Aneurysmal Subarachnoid Hemorrhage During the Intermediate Period: Waiting or Actively Treating

Perhaps the most difficult practical decision for neurosurgeons these days is whether to secure aneurysms during the intermediate period (4–10 days) after aneurysmal subarachnoid hemorrhage (SAH). We reviewed retrospectively a series of 115 patients with a Hunt–Hess grade I–III upon admission who were admitted 4–10 days after initial supratentorial aneurysmal SAH. Patients who underwent active treatment in the intermediate period were assigned to the intermediate group (n = 49), while those who accepted delayed obliteration of a ruptured aneurysm (11–30 days) were assigned to the late group (n = 66). The demographic characteristics, size and site of aneurysms, and clinical conditions were well balanced in the two groups. There was no difference in outcome between the two groups according to the Glasgow Outcome Scale (GOS) at discharge or a 6-month follow-up. Rebleeding before aneurysms obliteration was the leading factor resulting in poor outcome. In conclusion, for patients with supratentorial aneurysmal SAH who were in good clinical condition upon admission, active treatment during the intermediate period offered a good chance for a favorable outcome. An even larger number of patients from randomized clinical trials might be necessary to draw more reliable conclusions.     

The Role of Lumbar Drainage to Prevent Shunt-Dependent Hydrocephalus after Coil Embolization for Aneurysmal Subarachnoid Hemorrhage in Good-Grade Patients

Objective

To evaluate the role of lumbar drainage in the prevention of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by coil embolization in good-grade patients.

Methods

One-hundred-thirty consecutive patients with aneurysmal subarachnoid hemorrhage in good-grade patients (Hunt & Hess grades I-III), who were treated by coil embolization between August 2004 and April 2010 were retrospectively evaluated. Poor-grade patients (Hunt & Hess grades IV and V), a history of head trauma preceding the development of headache, negative angiograms, primary subarachnoid hemorrhage (SAH), and loss to follow-up were excluded from the study. We assessed the effects on lumbar drainage on the risk of shunt-dependent hydrocephalus related to coil embolization in patients with ruptured intracranial aneurysms.

Results

One-hundred-twenty-six patients (96.9%) did not develop shunt-dependent hydrocephalus. The 2 patients (1.5%) who developed acute hydrocephalus treated with temporary external ventricular drainage did not require permanent shunt diversion. Overall, 4 patients (3.1%) required permanent shunt diversion; acute hydrocephalus developed in 2 patients (50%). There was no morbidity or mortality amongst the patients who underwent a permanent shunt procedure.

Conclusion

Coil embolization of ruptured intracranial aneurysms may be associated with a lower risk for developing shunt-dependent hydrocephalus, possibly by active management of lumbar drainage, which may reflect less damage for cisternal anatomy than surgical clipping. Coil embolization might have an effect the long-term outcome and decision-making for ruptured intracranial aneurysms.     

颅内多发动脉瘤外科治疗的临床研究

目的研究颅内多发动脉瘤外科治疗的临床特点。方法回顾分析63例颅内多发动脉瘤病人的临床资料，将出院时的GOS评分作为预后良好（4—5级），差（1—3级），分别评价了年龄、性别、治疗手段、术前Hunt—Hess分级、Fisher分级、动脉瘤部位、侧别、大小、数量等因素的影响。结果GOS评分预后良好49例，差14例。单因素分析显示术前Hunt—Hess分级和Fisher分级与预后相关（P〈0．05）。多因素的Logistic回归分析结果显示各因素与预后均无明显相关（P〉0．05）。结论术前Hunt—Hess分级和Fisher分级会影响颅内多发动脉瘤病人的疗效，治疗方案的选择会提高其疗效。手术和介入的治疗效果未见明显差异。     

Clipping versus coiling: neuropsychological follow up after aneurysmal subarachnoid haemorrhage (SAH)

Patients treated with microsurgical clipping of ruptured intracranial aneurysms often suffer from neuropsychological deficits in spite of a good neurological outcome. The purpose of this study was to explore if the deficits are related to the type of therapy. Two groups of 16 patients each suffering from aneurysmal SAH, matched for sex, age, aneurysm-site and Hunt and Hess score, and 16 control subjects were examined with a battery of neuropsychological tests including memory, attention, and executive function. Depression, mood, and quality of life were also assessed. One patient group had been treated with surgical clipping, the other with endovascular coiling. Both patient groups showed deficits in verbal and visual memory. Clipped patients were slightly more impaired than coiled patients, especially on measures of affect and on a self-assessment measure of executive function. The pattern of results suggests that the neuropsychological outcome after aneurysmal SAH is affected by both the severity of the bleeding and the type of therapy.     

老年人颅内动脉瘤的外科治疗

目的探讨老年人颅内动脉瘤,尤其是破裂动脉瘤较理想的临床诊治方案.方法术前根据Hunt-Hess分级行病情评价,先后采用Yasargil入路和微创锁孔入路夹闭老年人颅内动脉瘤23例,出院时根据Glasgo预后评分(GOS)评价预后.结果Hunt-Hess 1～3级18例中,15例取得了良好的预后,死亡2例;5例Hunt-Hess 4～5级病人预后不良,其中3例死亡.结论高血压是老年人颅内动脉瘤形成和破裂的重要影响因素;病人的生理状况、家属和(或)病人的意愿是确定手术的主要依据;对Hunt-Hess分级1～3级者应争取早期手术治疗;微创锁孔手术尤为适用.