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Journal of Korean Neurosurgical Society 2006;40(1): 16-21.
Mortality and Morbidity of Aneurysmal Neck Clipping during the Learning Curve.
Sang Ho Lee, Hyung Sik Hwang, Seung Myung Moon, Sung Min Kim, Sun Kil Choi
Department of Neurosurgery, College of Medicine, Hallym University, Seoul, Korea. hyungsik99@yahoo.co.kr
Young neurosurgeons need to focus on the mortality and morbidity of aneurysmal neck clipping to develop a personal experience with an initial series.
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.
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.
Experienced supervision or endovascular approach should be considered for the treatment of ICA and PCoA aneurysms during the learning curve.
Key Words: Aneurysmal neck clipping; Learning curve; Mortality; Morbidity
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