Article
Interdisciplinary treatment of unruptured intracranial aneurysms – an outcome analysis
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Authors
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M. Kunz
- Neurochirurgische Klinik und Poliklinik, Ludwig-Maximilians Universität, München
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Y. Bakhshai
- Neurochirurgische Klinik und Poliklinik, Ludwig-Maximilians Universität, München
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C. Schichor
- Neurochirurgische Klinik und Poliklinik, Ludwig-Maximilians Universität, München
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M. Holtmannspötter
- Abteilung für Neuroradiologie, Campus Großhadern, Ludwig-Maximilians Universität, München
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S. Zausinger
- Neurochirurgische Klinik und Poliklinik, Ludwig-Maximilians Universität, München
| Published: | April 28, 2011 |
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Outline
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Objective: To retrospectively analyze the characteristics, treatment and outcome of patients with unruptured intracranial aneurysms.
Methods: 483 patients (370:113 f:m, mean age 52 ± 10 y) with unruptured intracranial aneurysms were treated between 1999 and 2009 after an interdisciplinary treatment decision. Patient charts, clinical and radiological follow-up were reviewed with special regard to intraprocedural complications. Glasgow Outcome scale (GOS) and Scandinavian Stroke scale (SSS) at discharge and after a follow-up period (mean 18 ± 12 mo) were recorded.
Results: 325 surgical clipping and 178 endovascular coiling procedures were evaluated. Both groups did not differ in age, sex and vascular risk profile. Maximum aneurysm diameter was greater in patients with coiling (12.2 ± 8.9 mm vs. 8.6 ± 5.2 mm; p<0.001). A residual or recurrence of the treated aneurysm was observed more often in endovascularly treated patients (9.5% vs. 32%; p<0.001). No procedure-related death occurred in patients with clipping, whereas death occurred in four patients (2.5%) undergoing coiling. Surgery-related morbidity at discharge was 9.2% vs. 8.4% after endovascular procedures and improved thereafter to 4.3% vs. 5.1%. In 23 surgical (7.1%) and 9 (5.1%) endovascular procedures an intraprocedural aneurysm rupture was reported, which was detected in post-interventional CT scans in 7/23 of the surgical and in all endovascular procedures. Rupture during the endovascular procedure resulted in a fatal outcome in 4/9 patients within 24 h. Short- and long-term outcome of patients with procedure-related rupture was significantly worse after endovascular treatment. A new ischemic area could be detected by postprocedural imaging in 37 (11.4%) patients after clipping and in 19 (10.7%) patients after coiling, leading to a permanent neurological deficit due to new focal ischemia in 10/37 and 7/19 patients (3% of all patients in both groups), respectively. Patients with the evidence of a procedure-related cerebral ischemia did not differ with respect to GOS and SSS between both groups.
Conclusions: Treatment of unruptured intracranial aneurysms with surgical clipping and endovascular coiling was conducted with similar early (~9%) and late (~5%) morbidity with 3% of all patients with therapy-induced ischemic deficits. In the endovascular group, intraprocedural ruptures were less frequent but associated with relevant mortality.
