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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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Paraclinoid aneurysms – signs, symptoms, patient characteristics, and outcome – results of interdisciplinary management of 134 consecutive aneurysms at a single neurovascular centre

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  • J. Beck - Universitätsklinik für Neurochirurgie, Inselspital Bern, Bern, Schweiz
  • A. Raabe - Universitätsklinik für Neurochirurgie, Inselspital Bern, Bern, Schweiz
  • C. Fung - Universitätsklinik für Neurochirurgie, Inselspital Bern, Bern, Schweiz
  • H. Vatter - Klinik für Neurochirurgie, Universitätsklinikum Frankfurt am Main
  • J. Berkefeld - Institut für Neuroradiologie, Universitätsklinikum Frankfurt am Main
  • V. Seifert - Klinik für Neurochirurgie, Universitätsklinikum Frankfurt am Main

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.02-06

doi: 10.3205/09dgnc116, urn:nbn:de:0183-09dgnc1164

Published: May 20, 2009

© 2009 Beck 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: To analyze a consecutive series of paraclinoid aneurysm (paraA) as managed by a modern interdisciplinary treatment paradigm at a single neurovascular centre.

Methods: From 09/99 to 05/08 all patients with paraAs – ruptured, unruptured, symptomatic, additional, or incidental – were included. Clinical data, patient and aneurysm characteristics, treatment decision, clinical course, complications, angiographic and imaging results, death and outcome were prospectively assessed. Treatment decisions were based on an individual interdisciplinary discussion. All patients were assessed at discharge and at sixth months according to the modified Rankin scale.

Results: We present 102 consecutive patients with 134 paraAs, constituting 10.4% of all patients. There was a high rate of multiple aneurysms in patients with paraAs (p=0.017 vs. non-paraA). Mean age was 51.8±12.1 years; mean size of paraAs was 7.4±5.79mm. There was a high female preponderance of 7:1 vs. 1.8:1 for patients with non-paraAs; (P<0.0001). There were 117 admissions (incidental=67; SAH form ruptured paraA=26, SAH from another aneurysm=37, cranial nerve dysfunction=21) and 151 interdisciplinary treatment decisions: 47 endovascular (41 coiling, 6 attempted coiling), 36 microsurgical (28 clipping, 4 wrapping, 4 attempted clipping), and 68 observations. Fifteen patients had multiple treatments. The proportion of poor outcome at 6 months was 36%, 28%, and 58% for patients with SAH, 14%, 0%, and 0% for patients with cranial nerve deficits, and 0%, 0%, and 10% for patients with incidental paraAs for the surgical, endovascular and conservative treatment groups, respectively. ParaAs have specific features: (A) they are more often symptomatic, (B) significantly more women harbour paraAs with a very high ratio of 7:1, and (C) they are significantly more often associated with multiple aneurysms (average >2).

Conclusions: Modern treatment of paraclinoid aneurysms should be an interdisciplinary task at specialized centres. Microneurosurgical and endovascular treatment options should be seen as complementary treatment modalities and both options and multiple treatments are necessary in a significant proportion of patients. That patients with paraAs constitute a unique subgroup of all patients with intracranial aneurysm may be pertinent for further studies of e.g. of risk of rupture or genetic patterns.