Artikel
Management of patients suffering from infectious intracranial aneurysms – an institutional series and a systematic review of the literature
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Infectious intracranial aneurysms (IIA) represent a rare clinical entity with high mortality. However, data on management of patients suffering from IIAs is scarce. Therefore, we analyzed data of patients suffering from IIAs treated at the author’s institution and performed a systematic review of the literature.
Method: Between 2009 and 2015, 4 consecutive patients with infectious intracranial aneurysms were treated at the author’s institution. To gain a larger population, PubMed was searched for published studies or case series on patients with IIAs. Data including patient characteristics, radiological features, treatment modality, postoperative complications, medical treatment, as well as functional outcome was assessed and further analyzed. Outcome was dichotomized into favorable outcome (mRS 0-2) versus unfavorable outcome (mRS 3-6).
Results: Literature data, including the current series revealed a total of 79 aneurysms in 69 patients. Overall, favorable outcome was achieved in 35 of 69 patients (50%). 24% of patients suffering from IIA were treated conservatively with best medical treatment including antibiotic/antifungal therapy, 33% were treated surgically, and 43% were treated endovascular. Favorable outcome was achieved significantly more often in patients who were treated by clipping or coiling compared to patients treated only conservatively (p=0.02). However, surgical and endovascular treatment did not significantly differ in respect of functional outcome. However, additional antibiotic treatment was administered in 77% of the included patients.
Conclusions: Data of the present study suggests that surgically or endovascular treated patients with ruptured IIA might achieve a better functional outcome in comparison with conservative treatment. However, decision-making process in finding the optimal treatment strategy in this rare clinical setting should be based on an interdisciplinary consensus in each individual patient.