Mortality and Morbidity of Aneurysmal Neck Clipping during the Learning Curve.
- Author:
Sang Ho LEE
1
;
Hyung Sik HWANG
;
Seung Myung MOON
;
Sung Min KIM
;
Sun Kil CHOI
Author Information
1. Department of Neurosurgery, College of Medicine, Hallym University, Seoul, Korea. hyungsik99@yahoo.co.kr
- Publication Type:Original Article
- Keywords:
Aneurysmal neck clipping;
Learning curve;
Mortality;
Morbidity
- MeSH:
Aneurysm*;
Brain;
Brain Edema;
Cerebral Infarction;
Glasgow Outcome Scale;
Hemorrhage;
Humans;
Learning Curve*;
Learning*;
Logistic Models;
Mortality*;
Neck*;
Organization and Administration;
Rupture
- From:Journal of Korean Neurosurgical Society
2006;40(1):16-21
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Young neurosurgeons need to focus on the mortality and morbidity of aneurysmal neck clipping to develop a personal experience with an initial series. METHODS: Total 88 aneurysms from 75 patients who underwent neck clipping by the same operator from 2001 to 2004 were reviewed. Patients were divided into three groups: first year (Group I), second year (Group II), and third year (Group III) in each group. Location of aneurysm, age, Fisher grade, Hunter-Hess grade (H-H grade), postoperative Glasgow outcome scale (GOS), and complications related to surgical procedures were evaluated with Chi-square and logistic regression analyses. RESULTS: Fourteen patients had complications related to surgery (18.7%). The major causes of mortality and morbidity related to surgery were cerebral infarction, hemorrhage and brain swelling due to intraoperative rupture, brain retraction and vasospasm. Among the 4 cases of mortality were 2 patients in Group I, 1 patient in Group II and 1 patient in Group III, and location of aneurysms were 2 internal carotid artery(ICA) and 2 posterior communicating artery(PCoA) aneurysms. There were 4 morbidity and new neurological deficits in Group I, 4 in Group II and 2 in Group III. Although mortality and morbidity during the learning curve had a statistical significance in H-H grade, age (>60 years old), and aneurysm location (especially ICA aneurysm) as variables, mortality mainly occurred in ICA and PCoA aneurysms. CONCLUSION: Experienced supervision or endovascular approach should be considered for the treatment of ICA and PCoA aneurysms during the learning curve.
