Article
Follow-Up imaging after clipping of ruptured aneurysms: what happens with the neck remnants?
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Authors
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Jürgen Konczalla
- Goethe-Universitätsklinikum, Klinik und Poliklinik für Neurochirurgie, Frankfurt, Deutschland
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Florian Gessler
- Frankfurt, Deutschland
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Sae-Yeon Won
- Frankfurt, Deutschland
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Nazife Dinc
- Frankfurt, Deutschland
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Markus Bruder
- Frankfurt, Deutschland
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Stephanie Tritt
- Goethe-Universitätsklinikum, Institut für Neuroradiologie, Frankfurt, Deutschland
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Volker Seifert
- Frankfurt, Deutschland
| Published: | June 9, 2017 |
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Outline
Text
Objective: Whereas data of follow-up imaging after endovascular procedures is widely available, data after microsurgical clipping is rare. Nowadays, due to improved techniques in in neuro-imaging (e.g. 3D angiography), neck remnants are identified more often. Therefore, we analyzed our patients who underwent 3D angiography after microsurgical clipping to assess neck remnants both postoperatively and after follow-up.
Methods: Patient and aneurysm characteristics and treatment results were collected prospectively and analyzed retrospectively (2007 – 2015) including data from patient records and a review of imaging findings.
Results: During the study period of 9 years, 217 ruptured aneurysms (up to 27mm) were treated by microsurgical clipping, requiring 364 clips (mean 1.7 clips, range 1-9). The majority (>70%) of the aneurysms were located in the middle cerebral artery (n=87, 40%) or anterior cerebral artery (n=71; 33%).
In the postoperative high-resolution 3D-angiography, a complete occlusion was detected in 147 aneurysms (68%) and a small neck or residual filling was shown in 70 aneurysms (32%).
Mean Follow-up time was 2 years with a maximum of 7.5 years.
Of the patients with a neck remnant or residual aneurysm at postoperative imaging, 9 patients died due SAH complications and 29 had a follow-up imaging. In follow-up imaging, none of these patients had a recanalization.
Further, 44 of 123 surviving patients with complete occlusion had a follow-up imaging. None of the patients with complete occlusion displayed neck remnants or aneurysm recanalization in the follow-up imaging. We identified two de novo aneurysms distant to the site of clipping in patients with completely occluded aneurysms (3 month and 17 months after initial treatment).
Conclusion: All patients with complete occlusion in postoperative imaging displayed a complete occlusion in follow-up. Follow-up imaging in patients with neck or aneurysm remnant after microsurgical clipping of ruptured aneurysms identified no recanalization. Therefore, despite an increasing incidence of aneurysm remnants due to 3D angiography, microsurgical clipping showed an excellent long-term durability also for incompletely occluded aneurysms.
