Stručni rad

Procena ishoda u odnosu na način tretmana intrakranijalnih aneurizmi: analiza serije bolesnika lečenih na Klinici za neurohirurgiju Kliničkog centra Vojvodine u 2008. i 2009. godini

P. Vuleković1, S. Iđuški2 , V. Papić1 , V. Vrsajkov3 , Đ. Đilvesi1 , M. Karan1

1 Klinički centar Vojvodine, Klinika za neurohirurgiju 2 Klinički centar Vojvodine, Centar za radiologiju 3 Klinički centar Vojvodine, Klinika za anesteziju i intenzivnu terapiju


Sažetak
Uvod: Osnova tretmana pacijenata sa intrakranijalnim aneurizmama je sprečavanje ili smanjenje mogućnosti rupture aneurizme uz lečenje efekata subarahnoidalne hemoragije (SAH) i prevenciju komplikacija.
Cilj rada: Cilj rada je uporediti ishod kod bolesnika posle hirurškog, endovaskularnog ili samo konzervativnog tretmana kao i utvrditi u kojoj meri na ishod utiče opšte i neurološko stanje bolesnika prilikom prijema na kliniku.
Materijal i metode: U istraživanje su uključena 134 bolesnika lečena na Neurohirurškoj klinici, Kliničkog centra Vojvodine u 2008. i 2009. godini. U čitavoj seriji bolesnika posmatrani su polna i starosna struktura, klinički i neurološki status (vrednovan skalom Svetske federacije neurohirurga) i ishod (prema glazgovskoj skali ishoda). U odnosu na način tretmana bolesnika (hirurški, endovaskularni, konzervativni) posmatrani su distribucija aneurizmi na arterijama Vilisovog šestougla i ishod u odnosu na poremećaj kliničkog i neurološkog stanja.
Rezultati: Pacijenata muškog pola bilo je 34% a ženskog 66%. Prosečna starost bolesnika bila je 54,2 godine. Hirurški je tretirano 50% pacijenata, endovaskularno 16% a konzervativno 34%. Kod hirurški tretiranih pacijenata aneurizmu prednje cirkulacije imalo je 98,5% bolesnika; povoljan ishod 72,5% a letalan 23,2%. Kod endovaskularno tretiranih bolesnika aneurizmu prednje cirkulacije imalo je 72,7% bolesnika; povoljan ishod 86,4% bolesnika a letalan 9,1%.
Zaključak: Razlike u ishodu između hirurški i endovaskularno tretiranih bolesnika nisu se pokazale statistički značajnim. Aneurizme karotidnog sliva prevashodno su tretirane hirurški, dok su aneurizme vertebrobazilarnog sistema najčešće tretirane endovaskularno. Pogoršavanje kliničkog stanja bolesnika prati porast morbiditeta i mortaliteta.
Ključne reči: aneurizma, hirurški tretman, endovaskularni tretman, konzervativni tretman, ishod kod bolesnika, kliničko i neurološko stanje


Abstract
Introduction: The basis of treatment in patients with intracranial aneurysm is to prevent or reduce possibility of aneurysm rupture, with treatment of subarachnoid hemorrhage (SAH) effects and prevention of its complications.
Goal: The aim of this research is to compare outcome in patients after surgical, endovascular and conservative treatment and to determine the extent to which the general and neurological condition affects the outcome. Material and methods: The study included 133 patients treated at the Department of Neurosurgery, Clinical Center of Vojvodina, in 2008 and 2009. We observed sex and age structure, clinical and neurological status (valued by the World Federation of Neurological Surgeons Scale) and outcome (valued by the Glasgow Outcome Scale). In relation to patients’ treatment (surgical, endovascular, conservative) we observed aneurysms distribution in Willis’ circle arteries and outcome in relation to the clinical and neurological condition disorder.
Results: In this study 33% of patients were women and 67% men. Mean age was 54.2 years. Fifty percent of patients were surgically treated, 16% endovascularly, 34% conservatively. Anterior circulation aneurysm had 98.5% of surgically treated patients; favorable outcome 73.5%, lethal 22.1%. Endovascularly treated patients had anterior circulation aneurysm in 72.7%; favorable outcome in 86.5%, lethal in 9%.
Conclusion: Differences in outcome between surgically and endovascularly treated patients did not sign statistical significance. Anterior circulation aneurysms were primarily treated by surgery, while vertebrobasilar aneurysms were primarily treated endovascularly. Deterioration of clinical condition was followed by morbidity and mortality growth.
Keywords: aneurysm, surgical, endovascular, conservative treatment, outcome, clinical and neurological condition