gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Clinico-pathological correlations in ruptured versus unruptured cerebral aneurysms

Die Beziehung zwischen histopathologischem Befund und klinischem Verlauf bei rupturierten und nicht rupturierten Aneurysmen der Hirnbasis

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  • corresponding author M. Holling - Abteilung für Neurochirurgie, Paracelsusklinik Osnabrück
  • W. Paulus - Institut für Neuropathologie, Universitätsklinikum Münster
  • F. Albert - Abteilung für Neurochirurgie, Paracelsusklinik Osnabrück

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 09.120

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc337.shtml

Published: May 8, 2006

© 2006 Holling 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: Rupture of cerebral aneurysms is believed to occur due to structural changes or incomplete development of vessel walls. Intimal loss, a poorly developed lamina elastica interna, and a fibrotic or necrotic tunica media are commonly observed. The aim of this retrospective study was to examine these alterations in ruptured (ra) versus unruptured aneurysms (unra) and to analyze their correlation with clinical course.

Methods: Among patients operated from 2000 to 2005 because of cerebral aneurysm in our neurosurgical department, the surgeon decided to take specimens for histological examination from the clipped aneurysm dome in 103 cases (ra: n=89, unra: n=14, ♀=64%, ♂=36%) dependent on situs and aneurysm configuration. Specimens were fixed in formalin, embedded in paraffin and stained by hematoxylin & eosin and van Gieson's. The following histopathologic features were scored: infiltration of vessel –walls by leukocytes, presence of muscle cells of tunica media, fibrotic tissue, necrotic areas and periadventitial vessels. Patient’s charts were used to extract clinical information.

Results: Histological specimens of unra and ra differed with respect to presence of fibrosis (93% vs. 61%, p<0.05), muscle cells (86% vs. 39%, p=0.001), necrotic areas (0% vs. 49%, p=0.001), periadventitial vessels (7% vs. 28%, p=0.094) and infiltration by leukocytes (0% vs. 70%, p<0.001). Leukocytic infiltration in the ra group was associated with occurrence of vasospasms (flow velocity >120 cm/sec, p=0.014) and length of hospitalization (p=0.005).

Conclusions: Our results show differences in histopathologic appearance of ruptured versus un-ruptured cerebral aneurysms. Furthermore, leukocytic infiltrates may serve as indicators for a worse postoperative clinical course of the patient.