gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Clipped ruptured middle cerebral artery aneurysms – indications, clinical and radiological results

Meeting Abstract

  • T. Schoemberg - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • N. Özkan - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • O. Müller - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • M. Schlamann - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
  • I.E. Sandalcioglu - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • U. Sure - Klinik für Neurochirurgie, Universitätsklinikum Essen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 063

DOI: 10.3205/12dgnc450, URN: urn:nbn:de:0183-12dgnc4505

Published: June 4, 2012

© 2012 Schoemberg 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

Text

Objective: Endovascular occlusion is currently regarded as first choice treatment option for most intracranial aneurysms. However, middle cerebral artery (MCA) aneurysms are usually treated by microsurgical clipping due to their unique anatomical features. In this study, indications for surgery and outcome of patients with ruptured MCA aneurysms, who underwent microsurgical clipping, were evaluated.

Methods: Between 2004 and 2010 a series of 70 patients with ruptured MCA aneurysms, which were admitted to our institution were evaluated retrospectively. Initial clinical grade was classified according to the Glasgow Coma Scale (GCS), Hunt & Hess grade (HH) and the appearance of subarachnoid hemorrhage on baseline CT-scan (Fisher grade). Indication for surgery was assessed retrospectively from the patients’ records. The Glasgow Outcome Scale (GOS) was used to assess the clinical outcome. It was classified as favorable (GOS 4–5) or unfavorable (GOS 1–3). Radiological findings in postoperative CT scan and digital subtraction angiography (DSA) were assessed.

Results: Average age was 53.8 years (range 25–84 years). HH grade was 1–3 in 50% (n=35) and grade 4–5 in 50% (n=35). In 51 cases (72.9%) space-occupying intracerebral hemorrhages (ICHs) were observed (Fisher grade 4). During the 70 surgical procedures 76 aneurysms were clipped. 32 of the 76 aneurysms were small-sized (1–5 mm), 29 aneurysms were of medium size (6–10 mm) and only 15 aneurysms were large-sized (>11 mm). The presence of space-occupying ICHs was the most frequent indication for surgical treatment of the aneurysms followed by wide neck complex aneurysms and arterial branches arising from the neck and/or dome. Postoperative DSA showed an incomplete aneurysm clipping in 9 cases (12.9%). In six of these incomplete clipping was performed deliberately in order to preserve arterial branches arising from the parent vessels. In cases of a good initial clinical grade (HH 1–3) 25 patients (71.4%) showed a favorable outcome and no patient died in this group. Among the patients with poor initial clinical grade (HH 4–5) a favorable outcome was achieved in only 8 cases, whereas 9 patients died in this group.

Conclusions: The initial clinical grade was the most important predicting factor for the patients’ outcome. Indications for surgery were (1) the presence of ICH and (2) a complex anatomy. The latter increases the risk for incompletely occluded aneurysms. These individuals require radiological follow-up examinations to detect aneurysm re-growth.