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Treatment related morbidity of unruptered intracranial aneurysms – Results of a prospective single centre series with an interdisciplinary approach during a 6 year period (1999- 2005)
  1. Rüdiger Gerlach (r.gerlach{at}em.uni-frankfurt.de)
  1. Department of Neurosurgery JWG-University, Frankfurt/ Main, Germany
    1. Jürgen Beck (j.beck{at}em.uni-frankfurt.de)
    1. Department of Neurosurgery JWG-University, Frankfurt/ Main, Germany
      1. Matthias Setzer (matthias.setzer{at}kgu.de)
      1. Department of Neurosurgery JWG-University, Frankfurt/ Main, Germany
        1. Hartmut Vatter (h.vatter{at}em.uni-frankfurt.de)
        1. Department of Neurosurgery JWG-University, Frankfurt/ Main, Germany
          1. Joachim Berkefeld (berkefeld{at}em.uni-frankfurt.de)
          1. Institute of Neuroradiology, JWG-University, Frankfurt/ Main, Germany
            1. Richard Du Mesnil de Rochemont (mesnil{at}em.uni-frankfurt.de)
            1. Institute of Neuroradiology, JWG-University, Frankfurt/ Main, Germany
              1. Andreas Raabe (a.raabe{at}em.uni-frankfurt.de)
              1. Department of Neurosurgery JWG-University, Frankfurt/ Main, Germany
                1. Volker Seifert (v.seifert{at}em.uni-frankfurt.de)
                1. Department of Neurosurgery JWG-University, Frankfurt/ Main, Germany

                  Abstract

                  Objectives: To review the angiographic and clinical outcome of patients with unruptured intracranial aneurysm (s) (UIA) with regard to complications and successful obliteration by surgical clipping or endovascular coiling.

                  Methods: Data were derived from a prospective database of intracranial aneurysms from June 1999 through May 2005 with all patients having a 6 month follow up according to the modified Rankin Scale (mRS). Favourable outcome was classified as mRS 0-2. From a total of 691 patients included in the data base 173 patients harboured 206 UIA of whom 118 patients (133 UIA) were treated.

                  Results: Primary treatment assignment to surgical repair was in 91 and to endovascular treatment in 42 UIA. In 3 UIA (7.1%) endovascular treatment was not feasible and had to be abandoned. Definite treatment was performed by surgery in 94 UIA (81 patients) and endovascular obliteration in 39 UIA (37 patients). There was no death related to any treatment in this series. Immediately after treatment 6.4% of the surgical and 7.7% of the endovascular patients showed new neurological deficits, mainly related to cerebral ischemia. After 6 months three (2.3%) patients had treatment related unfavourable outcome, defined as mRS (>2), 2 patients after surgical and 1 patient after endovascular aneurysm repair (not statistically different, p=0.3; Fishers exact test). After surgical clipping complete occlusion of the aneurysm was achieved in 88 (93.6%) and near complete (small residual neck) in 4 (4.3%) out of 94 UIA. Two small posterior communicating artery aneurysms with a foetal type posterior communicating artery were wrapped. After endovascular treatment obliteration was complete in 26 (66.7%). Small residual neck was seen in 13 (33.3%), but none of the UIA showed residual aneurysm filling. Five patients of the endovascular group (13.9%) underwent repeated endovascular treatment after aneurysm re-canalization.

                  Conclusions: If patients are carefully selected and individually assigned to their optimum treatment modality, UIAs can be obliterated by surgery or endovascular treatment in the majority of patients with a low percentage of unfavourable outcomes. In this series the outcome was not dependent on treatment. However, the rate of re-canalization of UIA is higher after endovascular obliteration. After diagnosis of an UIA, an individual interdisciplinary decision is essential for each patient to provide the optimum management.

                  • clipping
                  • coiling
                  • complication
                  • unruptured intracranial aneurysms

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