Artikel
Cerebrovascular aneurysms: combined endovascular and neurosurgical approach in ten out of 94 patients within one year
Hirnarterielle Aneurysmata: kombinierte endovaskuläre und neurochirurgische Versorgung in zehn von 94 Patienten innerhalb eines Jahres
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Autoren
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D. Moskopp
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
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D. Breukelmann
- Klinik und Poliklinik für Anästhesie und operative Intensivmedizin, Universitätsklinikum Münster
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T. Niederstadt
- Institut für Klinische Radiologie, Universitätsklinikum Münster
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
Text
Objective
Even after the publication of the ISAT study, the optimal therapy for individual patients with cerebrovascular aneurysms remains a matter of debate. Whereas most of the studies focus on a potential superiority of either the endovascular or the neurosurgical approach alone, we present data regarding combined approaches.
Methods
From 12/2003 to 11/2004 all patients with aneurysms were included if they had been treated in both manners, either simultaneously or as a two staged procedure. Clinical status on admission was classified according to Hunt and Hess (HH) and the outcome after at least one month according to the Glasgow Outcome Scale (GOS).
Results
Ten out of 94 patients with aneurysms met the criteria (m/f-ratio: 2:8; age-range: 39 to 82 years; mean: 57 ys). All patients showed complex single or multiple aneurysms, with a total number of 26 aneurysms in the following locations: MCA 10; AcomA 6; ICA 3; Pericallosal 3; PcomA 2; ACA 1; SCA 1 - including four patients with mirror aneurysms of both MCA, one patient with five and two patients with four aneurysms. HH-grade for the ruptured aneurysm of each patient on admission was as follows: HH0=1; HH1=3; HH2=2; HH3=2; HH4=2. Seven patients were treated in a two staged procedure for 15 aneurysms. In addition, seven procedures with combined approaches were performed for 11 aneurysms within the same session. Seven grade 0 aneurysms in three patients are not yet treated. The reasons for combined approaches were as follows: complex configuration of the neck with origin of branches from the fundus (n=5: coil -> clip); distal loction of A2/3-aneurysms with spastic feeders (n=2: coil -> clip); endovascular perforation of the fundus with acute bleeding (n=1: coil -> clip); incomplete clipping (two AcomA-aneurysms: clip -> coil). Outcome at one to twelve months (mean: 7 months) after the procedure was: GOS1 (best)=6; GOS3=1 (re-rupture during trepanation with ICH); three women died becaus of arterial spasms (GOS%: 39 ys - AcomA, MCA; 67 ys - AcomA, ICA, bilateral MCA; 82 ys - AcomA).
Conclusions
Combined endovascular and neurosurgical treament of aneurysms has the advantage of synergistic effects. Individualized concepts and confidental cooperation from both disciplines is mandatory for good outcome in patients with cerebrovascular aneurysms.
