Abstract
A middle cerebral artery aneurysm (MCAn) is apt to be regarded as comparatively easily accessible and the parent artery more capable of being secured compared with aneurysms in other sites. Unexpectedly, however, activity of daily living (ADL) in such MCAn are not seldom unfavorable. Influences of various factors on postoperative outcome of 122 well-documented cases, out of a total of 151 cases of MCAn, are discussed in this paper.
There were 52 male and 70 female patients (1: 1.35). The following study was made on a group with good outcome (G) showing an ADL of 1, 2, and 3 and a group with poor outcome (P) showing an ADL of 4, 5, and 6. Group G and P included 92 cases (75.4%) and 30 cases (24.6%) and averaged 50.3 and 56.8 years, respectively, indicating a correlation between age outcome (p<0.01). There is no significant correlation between sex on number of aneurysms and the outcome. As for the shape of the aneurysm, major axis, major axis/neck and major axis/minor axis were 8.47, 1.68, and 1.35 for Group G and 8.78, 1.79, and 1.41 for Group P, indicating a correlation not only between aneurysmal shape and the prognosis (p<0.05) but also between preoperative grading (p<0.05) and the prognosis. Repetition rate of subarachnoidal hemorrhage (SAH) was 1.29 for Group G and 1.66 for Group P, in 50% of which a plurality of SAH was observed (p<0.05). The preoperative grade and the SAH grade (5 stages) were 1.86 and 2.79 for Group G and 3.33 and 3.86 for Group P, indicating a close correlation between each of these two parameters and the outcome (p<0.000001). There was also a correlation between the SAH-Ope interval and the outcome (p<0.01); early operation was included predominantly in Group P. As for preoperative findings, premature rupture occurred in 11 of 92 cases (12%) in Group G and in seven of 30 cases (23%) in Group P, i. e. abuot twice the Group G rate, and both the quantity and the color of CSF outflow from the chiasmal cistern showed close correlation with spasm (p<0.01), onset of hydrocephalus (p<0.01) and the outcome (p<0.001). Moreover, spasm and hydrocephalus grade itself also showed close correlation with the outcome (p<0.000001). Hematoma grade (5 stages) was 1.45 for Group G and 2.82 for Group P, being regarded as one of the most influential factors on the outcome (p<0.000001). Blood pressure was also an important factor in hemodynamic stress; all of blood pressure grade (5 stages), BP max, BP min, BP fluctuation showed correlations not only with preoperative grade (p<0.001) and prognosis (p<0.0001) but also with SAH frequency, number of aneurysms, and major axis/neck ratio.
Multiple factors were thought to be involved in the prognosis; with the complex interrelations of these factors having a great influence on the outcome.
