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Ruptured intracranial aneurysms--learning from experience

R S Maurice-Williams1, N D Kitchen

  • 1Royal Free Hospital and School of Medicine, London, UK.

British Journal of Neurosurgery
|January 1, 1994
PubMed
Summary
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Surgical outcomes for ruptured intracranial aneurysms significantly improved over 13 years. Increasing surgical experience reduced mortality and improved patient recovery, highlighting the impact of operative skill on patient management.

Area of Science:

  • Neurosurgery
  • Neurology
  • Critical Care Medicine

Background:

  • Ruptured intracranial aneurysms present a significant cause of mortality and morbidity.
  • Optimal timing and surgical approach remain critical factors in patient management.
  • Delayed surgical intervention is common, often exceeding 10 days post-hemorrhage.

Purpose of the Study:

  • To assess the 1-year treatment outcomes for 400 consecutive patients with ruptured intracranial aneurysms.
  • To evaluate the impact of surgical experience on patient mortality and functional recovery.
  • To identify factors contributing to unsatisfactory outcomes and surgical complications.

Main Methods:

  • Analysis of data from 400 consecutive patients treated over 13 years by a single surgeon.

Related Experiment Videos

  • Categorization of patients into four 100-patient cohorts to track changes over time.
  • Contemporary analysis of reasons for unsatisfactory outcomes recorded during treatment.
  • Assessment of 1-year mortality and Glasgow Outcome Score (GOS) for all patients.

    • Main Results:

    • Overall management mortality at 1 year decreased from 38% to 24% across the four cohorts.
    • Surgical mortality at 1 year significantly reduced from 19% to 3%.
    • The proportion of patients achieving a GOS of 5 at 1 year increased from 73% to 90% among operated patients.
    • Postoperative deaths were primarily linked to surgical technical problems, which decreased from 15% to 1% over time.
    • Preoperative deaths, largely due to rebleeding, accounted for the majority of fatalities.

    Conclusions:

    • Increasing surgical experience led to a steady improvement in the management of ruptured intracranial aneurysms.
    • Operative efficiency significantly improved, with a marked reduction in technical complications.
    • The study suggests that improvements in surgical skill, rather than changes in overall management strategy like early surgery, are key to better outcomes.