gms | German Medical Science

Objective: In symptomatic unruptured intracranial aneurysms (UIA), treatment, based on interdisciplinary decision-making is standard of care. However, data on long-term functional outcome are sparse. We therefore analyzed our in-house database for patients, treated on symptomatic UIAs either microsurgically or interventionally.

Method: UIAs were categorized as symptomatic in case of cranial nerve or brainstem compression. Symptoms were divided into mild (visual acuity 0.9-0.5, partial anopsia, incomplete affection of one oculomotor nerve, mild degree of motor dysfunction/ataxia) and severe (visual acuity <0.4, complete hemianopsia, complete affection of one oculomotor nerve or incomplete affection of more oculomotor nerves, disabling degree of motor dysfunction/ataxia). Long-term development of symptoms after treatment was assessed in a standardized fashion at the time of last follow-up.

Results: 100 symptomatic UIAs were identified; in these, 47/100 underwent microsurgical and 53/100 interventional procedures. Median follow-up was 14 months. 83 patients presented with cranial nerve (NII-NVI) compression (microsurgery/interventional 41/42) and 17 patients with brainstem compression symptoms (3/14). Altogether, 105 symptoms have been divided into mild [n=62; (microsurgery/endovascular-25/37)] and severe [n=43; 20/23] deficits. Severity of symptoms was correlated with the size of treated aneurysms (p=0.009). Overall, a recovery rate of 62/105 (59%) deficits was observed (full 25/105, partial recovery 37/105), whereas 30/105 (28.6%) deficits have been stabilized or worsened until last follow-up in 13/105 (12.4%). The severity of symptoms did not gain prognostic influence on the recovery rate (full and partial). The subgroup analysis revealed recovery rates of 73% in the microsurgical and 48% in the interventional group (p=0.017). Respective aneurysm diameter were 14.8mm and 18mm (p=0.04). Optic nerve compression symptoms were least likely to improve after treatment compared to other compression syndromes (p=0.03). Visual acuity and visual field perimetry improved in only 52%, whereas 65% of deficits caused by other cranial nerve and brain stem compression.

Conclusions: Taken together, we were able to show that there is symptom recovery in the majority of patients with symptomatic UIAs after treatment on long-term perspective. Subgroup analysis revealed that symptom recovery was superior in the group treated microsurgically, which might be attributable to the reduction of space-occupying effects.