gms | German Medical Science

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

Durability of aneurysm clipping – evaluation by means of computed tomography angiography

Meeting Abstract

  • 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. DocDI.10.04

DOI: 10.3205/11dgnc168, URN: urn:nbn:de:0183-11dgnc1688

Published: April 28, 2011

© 2011 Kunert et al.
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Outline

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Objective: The aim of the study was to assess the durability of aneurysm clipping by means of computed tomography angiography (CTA) in a long-term follow-up.

Methods: The CTA examination was performed in 119 patients in whom 143 aneurysms were clipped. The examinations were performed 3 to 11 years (mean 6 y.) after clipping. GE Lightspeed PRO16 scanner with postprocessing 3D reconstructions was used for analysis, in all cases intravenous contrast medium (Iomeron 400, Bracco-Altana Pharma, 50-60 ml, v- 4 ml/s) was given.

Results: Good-quality images of CTA suitable for the evaluation of the arteries around the clip site were obtained in all cases. Complete neck closure with correct filling of vessels around the clip site was confirmed in 137 (96%) aneurysms. In 4 (3%) neck remnants were noticed (2 on ACoA and 2 on MCA), what could have been expected due to a complex anatomical configuration of aneurysms in these cases. Clip dislocation with aneurysm renewal was revealed in 1 case. The aneurysm was successfully treated by the endovascular implantation of flowdiverter stent. In one case, a later subarachnoid hemorrhage 11 years after clipping was noticed. The bleeding was caused by the renewal of ACoA aneurysm, near the previously placed clips. Among 6 patients with unsatisfactory clipping, 2 of them required further treatment and 4 remain under observation.

Conclusions: Computed tomography angiography is a simple and reliable method of evaluating aneurysm clipping. In the present study, the follow-up examinations revealed that 96% of the aneurysms were completely and permanently separated from the intracerebral circulation. The risk of unsatisfactory aneurysm closure was 4% and the risk of later SAH due to the regrowth of aneurysm was 1% in the 6 years after surgery.