Surgical treatment of unruptured intracranial aneurysms in a low-volume hospital - Outcome and review of literature

详细信息	查看全文 | 推荐本文 |

• 作者：M.A. Seule^a ; ^{martin.seule@kssg.ch} ; ^{seule@mac.com} ; M.N. Stienen^a ; O.P. Gautschi^a ; H. Richter^a ; L. Desbiolles^b ; S. Leschka^b ; G. Hildebrandt^a
• 关键词：Unruptured intracranial aneurysm ; Clipping ; Hospital volume ; Morbidity ; Mortality
• 刊名：Clinical Neurology and Neurosurgery
• 出版年：2012
• 期刊代码：60_03038467
• 类别：med
• 出版时间：July, 2012
• 卷：114
• 期：6
• 页码：668-672
• 文件大小：203 K

摘要

Background

The aim of this study was to evaluate surgical outcome of unruptured intracranial aneurysms (UIAs) in a low-volume hospital and compare the results with the recent literature.

Methods

A retrospective review of all consecutive craniotomies for UIA from July 1999 through June 2009 was performed. Morbidity was defined as modified Rankin Scale (mRS) 鈮?#xA0;3 and evaluated six weeks after surgery. Cognitive function was evaluated at rehabilitation-to-home discharge. A PubMed database search (2001-2011) seeking retrospective, single-center studies reporting on surgical outcome of UIAs was performed.

Results

There were 47 procedures performed in 42 patients to treat 50 UIAs (mean of 5 annual craniotomies). The mean age was 54.7 卤 12.1 years and mean aneurysm size was 7.6 卤 4.0 mm. Favorable outcome (mRS 0-2) at six weeks after surgery was achieved in 45 of 47 procedures (95.7%). Aneurysm size 鈮?#xA0;12 mm was statistically significant related to adverse outcome defined as mRS change 鈮?#xA0;1 (71%vs. 29%; p = 0.018). Five patients (10.6%) with favorable neurological outcome (mRS 2) presented with cognitive impairment at rehabilitation-to-home discharge. There was no significant difference in overall morbidity and mortality comparing low- and high-volume hospitals (4.0%vs. 4.8%; p = 0.85).

Conclusions

Low-volume hospitals may achieve good results for surgical treatment of UIAs. The results indicate that defining numeric operative volume thresholds is not feasible to guide centralization of aneurysm treatment.