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J Neurosurg Sci. 2007 Dec;51(4):159-68.

237 ACoA aneurysms clipped or embolized. Outcomes measurement using the De Santis-CESE assessment tool.

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Department of Clinical Sciences 'L. Sacco', Neurosurgery Unit, O. Galeazzi Institute, IRCCS, Milan University, Milan, Italy.



The aim of this retrospective study was to demonstrate the difference in patient outcomes after treatment for bleeding endocranial aneurysms when evaluated with methods based on different assessment criteria.


The outcome of 237 patients, 141 of which were operated on for anterior communicating artery aneurysm and 96 embolized, was assessed by a new method developed by De Santis. The patients operated on were assessed by the Glasgow Outcome Scale (GOS) and Rank Disability Scale (RDS) and the results of the latter were compared with the new method, the De Santis-CESE (Clinical Emotional Social Evaluation) method, which consists of a clinical evaluation and a numeric scoring system based on seven standard points. Comparison between the three methods showed significantly different outcomes. Patients who underwent surgical operation showed changes in character and behaviour, whereas the others showed cognitive, emotional and sexual habit changes.


Compared with the GOS and RDS instruments, the CESE method showed significant differences in patient outcome assessment, particularly regarding best outcomes. These differences may be due to the greater sensitivity of the CESE method over the other two scales. Furthermore, surgical patients seemed to achieve a better outcome than endovascular patients. The authors intend to conduct a prospective study to test the results obtained in this retrospective study.

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