gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Internal carotid bifurcation aneurysms: comparison of interdisciplinary treatment results and mid-term outcome

Meeting Abstract

  • Jürgen Konczalla - Klinik für Neurochirurgie, Universitätsklinikum, Frankfurt am Main
  • Nina Brawanski - Klinik für Neurochirurgie, Universitätsklinikum, Frankfurt am Main
  • Erdem Güresir - Klinik für Neurochirurgie, Universitätsklinikum, Frankfurt am Main
  • Richard du Mesnil de Rochemont - Institut für Neuroradiologie, Universitätsklinikum, Frankfurt am Main
  • Joachim Berkefeld - Institut für Neuroradiologie, Universitätsklinikum, Frankfurt am Main
  • Christian Senft - Klinik für Neurochirurgie, Universitätsklinikum, Frankfurt am Main
  • Johannes Platz - Klinik für Neurochirurgie, Universitätsklinikum, Frankfurt am Main
  • Volker Seifert - Klinik für Neurochirurgie, Universitätsklinikum, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.05.02

doi: 10.3205/14dgnc299, urn:nbn:de:0183-14dgnc2998

Published: May 13, 2014

© 2014 Konczalla 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: Aneurysms of the internal carotid artery (ICA) bifurcation are rare and no studies have compared patient outcomes after endovascular vs. surgical treatment. Here, we report the safety, efficacy, and follow-up outcome of these two treatment options for patients with ICA-bifurcation aneurysms.

Method: Patient information, aneurysm characteristics (size, projection and configuration), treatment results, and follow-up outcomes (at 30 months) were analyzed. Projections were defined as medially, laterally, superiorly, posteriorly and anteriorly. The configuration was divided in two groups: aneurysm, which originating only from the ICA-bifurcation, and aneurysms, which involving proximal A1-/M1-segment. If the aneurysm neck is located directly within the blood flow of the ICA and not partially involving the proximal A1- or M1-segment, we defined this aneurysms as “originating only from the ICA-bifurcation”.

Results: We treated a total of 58 patients with ICA-bifurcation between 1999 and 2012 including ruptured and unruptured aneurysms; 30 were assigned to coiling, and 28 were assigned to clipping. Patients who underwent surgical clipping were younger and had larger aneurysms than patients who underwent endovascular coiling. More patients were assigned to endovascular treatment if their aneurysms originated only from the ICA-bifurcation or projected superiorly. The near complete occlusion rate in endovascular treated patients was high (96%). Except for small neck remnants (to keep perforators open and to prevent A1- or M1-stenosis) all aneurysms could be clipped completely. At follow-up the recanalization rate after coiling was 46%. Multivariate analysis revealed that an aneurysm originating only from the ICA-bifurcation was an independent predictor of recanalization after coiling.

Conclusions: To our knowledge, this is the first report directly comparing outcomes of endovascular coiling and surgical treatment for ICA-bifurcation aneurysms. Our findings indicate that, when an aneurysm originates only from the ICA-bifurcation, the surgical treatment in experienced hands may be preferred over endovascular treatment.