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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

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Flow-assisted clipping of aneurysms, not suitable for coiling

Meeting Abstract

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  • J. Dings - Neurosurgical Department, University Hospital Maastricht, The Netherlands
  • V. Reijn - Neurosurgical Department, University Hospital Maastricht, The Netherlands

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.02-03

doi: 10.3205/09dgnc113, urn:nbn:de:0183-09dgnc1138

Published: May 20, 2009

© 2009 Dings et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Coiling of cerebral aneurysms is nowadays the preferred treatment. As a consequence operating on the remaining difficult ones inherits more risks (ischemia and sack/neck remnant). Tools such as the flow monitoring (transonic) enable the neurosurgeon to reduce the risk of ischemia and may enhance the rate of occlusion. The purpose of the retrospective study was to evaluate the incidence of ischemia after clipping guided by pre-, and postclipping flow monitoring and to find out whether this tool inherits any additional risk.

Methods: 122 pts (mean age was 54 (SD 11) years) harbouring 130 aneurysms (90 % mca and anterior communicating artery) were treated by the same neurosurgeon, 88% within 72 hrs in case of rupture. Apart from the Hunt – Hess grade 0 patients (23 aneurysms), all had grade 1 – 3 (1 + 2: 88 %). 5 patients had H+H 4 or 5 (with Fisher gr 4). Flow monitoring of mca branches and both A2 was performed before and after clipping.

Flow reduction of no more than 50 % was accepted (in accordance with the results of the Italian cooperative study). Temporary clipping was performed whenever necessary. All pts received orally administered nimodipine. On day 1 a CT scan was performed. Glasgow Outcome Score (GOS) at 6 months was determined (gos 4+5 vs. 1-3).

Results: There were no complications attributable to the flow monitoring.

None of the patients, except one, had clipping induced ischemia in one or more of the flow monitored vessels. In case of the patient with ischemia, the flow probe indicated no flow but the operating neurosurgeon trusted more the visible result because of strong vessel atherosclerosis.

GOS at 6 month was 4 + 5: 87 %, 1 – 3: 13 % (4 of these had fisher 4 sah, 3 had fatal vasospasm).

Conclusions: Flow monitoring enables a safe clipping of complex aneurysms that are not suitable for coiling.

There is no additional risk of complications attributable to the monitoring tool.