Clinical Analysis of Factors Influencing the Development of Delayed Ischemic Neurologic Deficit after Aneurysm Surgery.

Choi, Chun Sik; Kwon, Young Jun

Original Article

Journal of Korean Neurosurgical Society 2002;31(3): 241-246.

Department of Neurosurery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea.

ABSTRACT

OBJECTIVE
This study shows the factors influencing the development of postoperative delayed ischemic neurologic deficit.
METHODS
The authors analyzed 120 patients had performed aneurysmal neck clipping. Eleven variables were examined as to relationship to delayed ischemic neurologic deficit and classified as non- surgical and surgical variables. Data were analyzed by the univariate analysis and significant variables were entered into multiple logistic regression model in order to draw out Odds ratio.
RESULTS
Delayed ischemic neurologic deficit after aneurysm surgery developed in 23 patients(19.2%). Significant non-surgical variables were clinical grade at admission(p=0.032), CT grade(p=0.005), and degree of preoperative angiographic vasospasm. Surgical variables were timing of surgery, brain retraction time, and duration of temporary clip application. The application time of temporary clip was significant (p=0.032) in development of delayed ischemic neurologic deficit. However, in multiple logistic regression analysis, duration of temporary clip application was excluded. With the clinical grade I - II and the CT grade I - II as the reference, the Odds ratio were 2.358(95% CI 0.87-6.37) and 4.041(95% CI 1.06-15.37), respectively.
CONCLUSION
Delayed ischemic neurologic deficit after aneurysm surgery developed in poor clinical grade and high CT grade with high risk. The effect of surgery on the development of post-operative vasospasm was not significant.

Key Words: Delayed ischemic neurologic deficit; Effect of surgery; Temporary clipping