Results of Surgical Treatment of Patients with Ruptured Aneurysms of the Middle Cerebral Artery

Prirodov .*, Tkachev V.*, Dashyan V.**, Karamishev R.*, Krilov V.*

* Sklifosovsky Research Institute of Emergency Care, Moscow, Russia;
** Moscow State Medical Stomatological University, Moscow, Russia

 

The research goal was to determine outcomes in treatment of cases with ruptured aneurysms of the middle cerebral artery (MCA).

Material and Methods. A total number of cases with ruptured aneurysms of the CMA, treated at the Sklifosovsky Research Institute of Emergency Care since 0.1.01.1992 up to 31.12.2004, was 369. There were 175 males and 194 females. Their mean age was 46.3±11.6 years. Operations were performed in 330 cases (89%). All the patients (39), who were not treated surgically, died. The results were estimated with taking into account a sex, age, state severity according to Hunt & Hess scale (H-H), presence and volume of intracranial hematoma (ICH), a combination of the MCA aneurysms with an aneurysm of other localization, presence and severity of angiospasm (AS) according to data of angiography and transcranial Doppler. A state severity in operated cases was as follows (H-H): 8% - Grade I, 38% - Grade II, 44% - Grade III, 8% - Grade IV, 2% - Grade V.

Results. Outcomes of operated cases were reliably dependent on a state severity (r=0.418, p<0.001), ICH presence and volume (r=0.407, p<0.001), presence and severity of AS (r=0.302, p<0.01). Correlation dependence became more marked in a combination of three parameters (r=0.542, p<0.0001). AS and ICH were revealed in 5% and 9% of cases with Grades I and II (H-H) respectively. Outcomes, watched in this group, were as follows: good - 89%, satisfactory - 3%, fatal - 8%. The same indices in cases with Grade III (H-H) were as follows: AS - 20%, ICH - 24%, good outcomes - 68%, satisfactory outcomes - 6%, bad and fatal outcomes - 2% and 24% of cases respectively. Patients with Grades IV-V (H-H) were characterized by the following indices: AS - 85%; ICH -56%; good, satisfactory and fatal outcomes - 32%, 6% and 62% respectively.

Conclusions. Outcomes of cases with ruptured aneurysms of the MCA are reliably dependent on a state severity, estimated according to Hunt & Hess scale, and such factors, conditioning this severity, as presence and volume of ICH, presence and severity of AS and their combination.