gms | German Medical Science

64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. - 29. Mai 2013, Düsseldorf

Anatomical variants of the sylvian fissure and its influence of operative procedure and outcome after clip occlusion of intracranial aneurysms

Meeting Abstract

  • Hannah Ngando - Klinik für Neurochirurgie, Klinikum Duisburg, Akademisches Lehrkrankenhaus der Universität Essen-Duisburg, Duisburg
  • Homajoun Maslehaty - Klinik für Neurochirurgie, Klinikum Duisburg, Akademisches Lehrkrankenhaus der Universität Essen-Duisburg, Duisburg
  • Athanasios K. Petridis - Klinik für Neurochirurgie, Klinikum Duisburg, Akademisches Lehrkrankenhaus der Universität Essen-Duisburg, Duisburg
  • Martin Scholz - Klinik für Neurochirurgie, Klinikum Duisburg, Akademisches Lehrkrankenhaus der Universität Essen-Duisburg, Duisburg

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocDI.12.02

doi: 10.3205/13dgnc276, urn:nbn:de:0183-13dgnc2769

Veröffentlicht: 21. Mai 2013

© 2013 Ngando et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: Yasargil described variations of the anatomy of the Sylvian fissure (SF) and created four sub-groups. Depending on the configuration, surgical opening of the SF and exposure of the imbedded anatomical structures might be more difficult. In the present study we aimed to evaluate, whether the anatomical variations influence the surgical strategy and the outcome in operatively treated intracranial aneurysms.

Method: Charts of the last 220 patients, who underwent clipping of one or more aneurysms through trans-sylvian approach, were reviewed. The clinical course and the data of neuro-imaging, considering postoperative oedema and /or ischemic stroke were analyzed in regard to the clinical outcome, using the Glasgow outcome scale (GOS) and the modified Rankin Scale (mRS). Statistical analysis was done using the Fisher's exact test and Chi-square. Statistical significance was estimated as p-value <0.05.

Results: In total we analyzed the data of 221 patients with 233 aneurysms, n=135 ruptured (57.9%) and n=98 (42.06%) un-ruptured aneurysms. Anatomical analysis showed that 45.9% (n=107) were categorized as SF grade 1, 37.8% (n=88) as grade 2, 12.4% (n=29) as grade 3 and 5.6% (n=13) as grade 4. The sub-division according to ruptured / un-ruptured aneurysms showed a higher incidence of grade 1 in ruptured (51.6%) and higher incidence of grade 2 in un-ruptured aneurysms (44.9%). The anatomical characteristic of the SF did not influence the outcome in the SAH group, since the grade of SAH was the most important predictive factor. On the other hand, the type of the SF had influence on occurrence of oedema and hypodensity on CT scanning. Circumscribed mild postoperative oedema occurred in 29 cases (29.6%) and small peri-sylvian hypodensity in 5 cases (5.1%). All cases remained without clinical relevance. Grade 2 SF was represented most frequently in both groups. However, the statistical analysis showed no significance. Ischemic stroke of the MCA territory occurred in one case (0.01%) with transient hemiparesis.

Conclusions: After analysis, we conclude that the configuration of the SF did not primarily influence the outcome in SAH patients. Several other factors were more predictive. Concerning the un-ruptured aneurysm group, the grade of SF should be considered preoperatively, especially in teaching cases to avoid oedema and ischemic stroke. This issue might be important to maintain the quality of aneurysm surgery in the future. Prospective studies are needed to verify our observations.