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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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The significance of de novo aneurysms in patients following aneurysmal subarachnoid hemorrhage

Meeting Abstract

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  • P. Kunert - Department of Neurosurgery, Medical University of Warsaw, Poland
  • M. Prokopienko - Department of Neurosurgery, Medical University of Warsaw, Poland
  • M. Gola - II Department of Radiology, Medical University of Warsaw, Poland
  • T. Dziedzic - Department of Neurosurgery, Medical University of Warsaw, Poland
  • M. Chojnowski - Department of Neurosurgery, Medical University of Warsaw, Poland
  • A. Marchel - Department of Neurosurgery, Medical University of Warsaw, Poland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.11.02

doi: 10.3205/11dgnc079, urn:nbn:de:0183-11dgnc0794

Published: April 28, 2011

© 2011 Kunert 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: The aim of the study was to assess the risk of de novo aneurysm (dnA) formation in patients after aneurysmal subarachnoid hemorrhage (SAH).

Methods: Computed tomography angiography (CTA) was performed in 119 patients 3 to 11 years (mean 6) after clipping of a ruptured aneurysm. In the series analyzed, hypertension coexisted in 56%, smoking in 43%, family history of intracranial aneurysms in 7% and polycystic kidney disease in 8%. The various factors that could affect de novo aneurysm occurrence were analyzed.

Results: 19 small dnA were found in 14 (12%) patients in remote locations with respect to the clip site (in 11 patients single and in 3 multiple aneurysms). Aneurysm diameter ranged from 1.6 to 5 mm. In the majority of cases the aneurysms were located at the ICA (9/19.47%) and MCA (8/19,42%). None of the new aneurysms were the cause of subarachnoid hemorrhage during a mean of 6 years of observation. The only significant factor that influenced dnA occurrence was female gender (p=0.015). The risk of a dnA formation in women was 16% (14/86), while none of the 33 men had a new aneurysm. The other factors examined did not significantly increase the risk of dnA formation. In patients examined <5 years after SAH, the risk of dnA was 9% (5/55), in the period 6–10 years 12% (6/50) and >10 years 21% (3/14), but the differences were not statistically significant. One de novo MCA aneurysm was clipped during the surgery because of the rupture of a recurrent ACoA aneurysm 11 years after primary bleeding. Routine CTA examination one year after initial dnA diagnosis revealed that four dnA out of 18 have enlarged slightly. However, they are still small (up to 3mm in diameter) and no treatment is needed.

Conclusions: The risk of de novo aneurysm formation was 12% in the mean period of 6 years after SAH. None of the aneurysms ruptured during the follow-up period. Female gender increases the risk of dnA formation. These results confirm that patients are still at risk of new aneurysm formation and eventually intracranial bleeding even after successful clipping of ruptured aneurysms. Thus, periodic non-invasive examinations such as CTA or MRA should be considered.