Artikel
Morphology and size of ruptured and innocent cerebral aneurysms – Impact on neurological outcome in surgically treated patients
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Autoren
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A. Herbst
- Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität Regensburg
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M. Proescholdt
- Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität Regensburg
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A. Brawanski
- Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität Regensburg
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K.M. Schebesch
- Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität Regensburg
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Initial neurological status (WFNS, Hunt and Hess, HH), amount and configuration of subarachnoid blood (Fisher score), presence of hydrocephalus and relevant co-morbidities are well established predictors of outcome after subarachnoid hemorrhage (SAH). The risk of rupture is related to size and morphology of the aneurysm, but until now, these features have not been evaluated in the context of neurological outcome independent from the treatment modality. In this retrospective analysis we correlated shape and size of the aneurysm and the neurological outcome in a large cohort.
Methods: Retrospectively, we reviewed the charts, preoperative angiograms and CT-scans of 429 consecutive patients with ruptured or innocent aneurysms of the anterior and posterior circulation that were admitted to our department. 392 patients were included in this study. 274 patients (69.9%) presented with SAH. 243 patients were treated surgically (clip ligation). We analyzed and statistically correlated the preoperative neurological condition, aneurysm morphology (shape, diameter, calcification, thrombi, adherent and branching vessels, neck/dome ratio, parent vessel diameter), surgical strategy (temporary clip, surgery time, intraoperative rupture) and postoperative neurological outcome (Neurological Performance Score, NPS).
Results: The maximum diameter of the aneurysm was significantly correlated to the initial HH score, WFNS score and to the NPS immediately postoperatively and during follow-up. The diameter of the aneurismal dome and neck, and the dome-basis ratio were also correlated to the NPS postoperatively. Furthermore, aneurismal diameter, dome-basis ratio and dome diameter were significantly correlated to the number of clips applied, to the clip length and to the time for intermediate clipping of the parent artery.
Conclusions: In this large series we clearly identified morphological features of cerebral aneurysm that potentially predict challenging surgical conditions, thus influencing neurological outcome. Detailed preoperative imaging should always be assessed and radiographic evaluation should focus on morphological aspects, shape and size of the aneurysm, particularly.
