Factors influencing the outcome after the operative treatment of cerebral aneurysms of anterior circulation

Analysis of the impact of intraventricular hemorrhage on the functional outcome of ruptured anterior cerebral artery aneurysm after clipping

Background

Various clinical symptoms and variables have been suggested as potential indicators of outcomes in patients with subarachnoid hemorrhage (SAH) resulting from ruptured intracranial aneurysms. The detailed discussion of the consequences of intraventricular hemorrhage (IVH), frequently reported in cases of anterior communicating artery (ACoA) aneurysms, is still pending. The study aimed to assess the results of aneurysm surgery performed early versus delayed in patients with SAH, specifically focusing on the occurrence of IVH.

Methods

This study involved patients with ACoA aneurysms who experienced SAH and underwent microsurgical clipping of the aneurysm. A retrospective review was conducted on the patients' medical records. The modified Rankin score was compared between two groups of patients based on the presence or absence of IVH.

Results

Ninety-one participants (52 males and 39 females) were included in the study. The initial computed tomography scan showed that 20 patients (with a mean age of 51 ± 13.7 years) had IVH, while 71 patients (with a mean age of 45.8 ± 11.7 years) did not have any signs of IVH. The proportion of patients with poor functional outcomes after six months was 55% in the presence of IVH, compared to 25.4% in patients without IVH, indicating a significant difference in outcome between the two groups (P < 0.016).

Conclusion

Patients with SAH having aneurysms located in the ACoA associated with the intraventricular hemorrhage had a poor functional outcome.

Outpatient rehabilitation of patients with chronic cognitive impairments after ruptured anterior communicating artery aneurysms reduces the burden of care: A pilot study

PRIMARY OBJECTIVE

To describe the functional outcome of 19 patients with anterior communicating artery aneurysm following the completion of an inter-disciplinary out-patient rehabilitation programme.

RESEARCH DESIGN

Retrospective descriptive study.

SETTING

Community-based inter-disciplinary outpatient programme.

PATIENTS

n = 19; consecutive referred sample, mean 182 days post-onset; in-patient rehabilitation completed.

INTERVENTION

Inter-disciplinary treatment of functional activities; 2-5 hours/day, 3-5 days/week; mean duration: 55-57 days.

MAIN OUTCOME MEASURES

Supervision rating scale (SRS) and change in prevalence at admission and discharge of executive impairments, memory, confabulation, apathy, initiation, social inappropriateness and incontinence.

RESULTS

Sixty per cent of the patients showed a clinically significant improvement in their SRS from requiring full-time supervision to part-time supervision. Change in SRS was correlated with change in the impairments of executive function, memory and confabulation.

CONCLUSION

Although pervasive impairments associated with this disorder may limit capacity for even moderate independence, substantial reduction in direct supervision by family members may be achieved.