Clinical Analysis in Cerebral Aneurysm of Posterior
Circulation in Elderly Patients |
Chul Woong Park , Jung Yul Park , Sang Dae Kim, Se Hoon Kim , Dong Jun Lim |
Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea |
노인 연령 환자에서 후순환계 뇌동맥류의 임상 분석 |
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Abstract |
Objective The posterior circulation aneurysms are less common than those of anterior circulation and the prognosis
of patients with aneurysm in posterior circulation is usually poor due to the difficulty of operation. We evaluated the
various factors related to the outcome of posterior circulation aneurysm and compared results between the conventional
clipping operation and the endovascular therapy.
Methods Between Jan, 1998 to May, 2007, a total of 867patients were diagnosed of aneurysm by the angiography,
and of these, the 52 (7.8%) patients of posterior circulation aneurysm were selected. We studied the factors which
could affect the results such as the initial H-H grade, location of aneurysm, size of aneurysm and the therapeutic
modalities. Treatment outcome was evaluated with the Glascow Outcome Scale (GOS) at 6 months after initial insult.
Results The patient population consisted of 35 women and 17 men, with a mean age of 62.8 years (range 60-81
years). The overall mortality and morbidity rates at 6 months were 17.3% and 13.5%, respectively. We have operated
on 31 patients and 16 patients underwent endovascular therapy and all craniotomies were carried out after 2 weeks
from initial insult. Twenty-one patients received only conservative treatment due to aneurysms classified as inoperable,
poor neurological status including fatal rebleeding, refusal against surgery, and one aneurysm that spontaneously
disappeared. Better prognosis, over GOS 4, was seen in 21 patients (84%) out of 25 patients who had Hunt and
Hess (H-H) grades I and II at the initial state than those with poor H-H grades (p<0.001). Also, better prognosis was
seen in 14 patients(87.5%) out of 16 patients who had proceeded with the endovascular therapy (p=0.032). As for
the comparison of outcome according to the size and the location of aneurysm, and age of the patients, we found no
statistically significant difference.
Conclusion The important factors that affected the prognosis of our series were the initial H-H grade and the
treatment modality. Considering the very high mortality from rebleeding, early management may contribute to improvement
of the prognosis in posterior circulation aneurysm. The result of treatment was improved after applying the
endovascular therapy. Thus, as for the primary treatment modality, the endovascular therapy should be considered
in the treatment of the posterior circulation aneurysm. |
Key Words:
ElderlyㆍPosterior circulationㆍOutcomeㆍPrognosis |
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