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This study was designed to clarify the various factors associated with the poor prognosis of the dorsal aneurysm of the internal carotid artery. Three hundred sixty-five aneurysms diagnosed by angiography were registered from 171 institutes in Japan by questionnaire between January 2001 and December 2003. The average age at diagnosis was 53.8 years among 105 men and 233 women patients. Sixty-eight aneurysms were located in C1, 74 in C1-2 and 213 in C2. Three hundred thirty-nine aneurysms obtained Glasgow outcome score (GOS) of all 365 aneurysms were extracted and classified into group A (Good Recovery (GR), Moderate Disability (MD)) and group B (Severe Disability (SD), Vegetative State (VS), Dead (D)) for analysing various factors. Poor prognostic factors were assessed by single variate analysis. Significant prognostic factors are rupture as onset (Odds ratio [OR] 9.9850), intraoperative bleeding (OR 6.3979), postoperative regrowth of the aneurysm (OR 5.8586), preoperative rebleeding (OR 5.1278), postoperative bleeding (OR 4.6397), Hunt-Kosnik grade greater than 3 (OR 4.5247), suspicion of dissecting aneurysm on angiogram (OR 3.5023), World Federation of Neurosurgical Societies (WFNS) grade greater than 3 (OR 3.2734), diagnosis as dissection in the operative field (OR 3.2296), thin aneurysm neck (OR 3.0252), thin aneurysm dome (OR 2.8794), temporary occlusion of the cervical carotid artery (OR 2.8667), and Fisher group greater than 3 (OR 2.3564). No significant differences were observed in the history, including hypertension, age, sex, size of an aneurysm dome and neck, presence of other aneurysms for the poor outcome. Observation therapy, i.e., no treatment, was correlated with poor outcome. Any perioperative bleedings strongly correlated with poor outcome. We should pay more attention to patients with a regrowing, thin walled aneurysm than to those with a larger aneurysm. Since the conservative treatment does not result in the good outcome, we need to treat those patients in the early stage.

The Nationwide Surveillance on the Dorsal Aneurysm of the Internal Carotid Artery Part 1: Analysis of the Factors Affecting the Poor Outcome