Epidemiology And Treatment Of Cerebral Aneurysms At An Australian Tertiary Level Hospital

摘要

Treatment of aneurysms has remained controversial in the last decade with protagonists for both coiling and clipping. This is a long-term retrospective audit of the management of aneurysms at an Australian tertiary level hospital. A novel method of retrospective analysis was undertaken, utilizing the radiological reporting system to identify patients presenting to the PAH with an aneurysm.4762 reports were flagged and of these, 556 patients were identified and their treatment tabulated. The number of cases treated per year has remained stable; coiling has increased as clipping has decreased. Introduction The incidence of subarachnoid haemorrhage (SAH) from intra-cerebral aneurysm rupture is approximately 10 per 100,000 people per year1. The consequence of this is significant given the associated morbidity and mortality as well as its occurrence within a relatively young age group2.The ISAT in 2001 reported that patients with ruptured intracranial aneurysms showed a 1-year survival benefit with surgical coiling rather then endovascular clipping3. It focused on patients presenting with a low World Federation of Neurosurgical Societies (WFNS) clinical grade < 2 and with small (< 10mm) aneurysms arising from the anterior circulation3. ISAT famously foreshortened its trial due to safety issues when initial results indicated that coiled patients have better outcomes in terms of mortality and morbidity3,4. The 5-year data published in 2009 indicates that this primary end point is no longer significant3,4. Coiling was still however linked with a lower mortality3.Many places have altered their treatment protocols in response to this reported benefit. This paper has sought to ascertain the treatment trends at our institution. A subsequent paper will address outcomes. Methods A retrospective analysis of patient records from a single hospital, The Princess Alexandra Hospital (PAH) in Brisbane Queensland, was conducted in order to identify appropriate patients for this study. The Princess Alexandra is one of three tertiary level hospitals servicing Queensland, Australia. Approximately 90,000 patients are seen each year, including referrals from regional and rural Queensland hospitals. All patients who have undergone a radiological procedure at the PAH from 2001 to December 31st 2011 were entered into a central database called ‘SORTS’. Using this database as a starting point, the appropriate patients were identified using the words “+ cerebral + aneurysm” as a filter. This returned 4762 results. These results were for all computerized tomography (CT) head, CT neck, CT angiogram, digital subtraction angiogram (DSA), IA (Intracranial aneurysm) coiling and magnetic resonance imaging (MRI). This information was further filtered through a single-examiner viewing of all radiological reports. Patients for whom an aneurysm was identified and went onto definitive treatment were entered into the study. If a single aneurysm required multiple treatments it was counted as a single entry.The exclusion criteria were patients where no aneurysm was identified, patients diagnosed with an aneurysm that was not for treatment and patients diagnosed with other cerebral or vascular pathology. After this criterion was executed 1462 patients remained.The final result of 556 was achieved by removing all multiple entries as a result of follow up scans.This resulted in a database of patients presenting with an aneurysm that lead to treatment. Once they were known, a chart and electronic discharge summary review was conducted to determine epidemiological information such as age, age at presentation, presenting complaint, WFNS grade, vessel location, vessel size and treatment. Results Between January 1st 2001 and December 31st 2011, 556 patients presented for the first time to the PAH with an aneurysm that was treated. Three hundred and thirty five patients were female and 221 were male. Figure 1.