Artikel
Institutional seven years experience in the treatment of ruptured aneurysms
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Autoren
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Julia Zobel
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Germany
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Ali Ayyad
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Germany
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Axel Neulen
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Germany
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Angelika Gutenberg
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Germany
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Alf Giese
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Germany
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Sven R. Kantelhardt
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Recent studies investigated the natural history of cerebral aneurysms. These showed a correlation between aneurysm size and rupture risk, which consequently resulted in the recommendation not to treat small incidental aneurysms. We therefore investigated the size and clinical course of ruptured aneurysms treated in our institution within a 7 years period.
Method: We performed a retrospective analysis of patient records and imaging data of all patients treated for ruptured aneurysms in our institution between 2007 and 2013.
Results: 269 patients were included (average age 55,5 years, 67% females). Aneurysm size ranged from 1-25mm in diameter, with the majority of ruptured aneurysms at about 5mm diameter. 43% of the ruptured aneurysms were found to be 5mm or smaller in diameter. 83.3% of the aneurysms were located in the anterior circulation. 33.5% of the patients had multiple aneurysms. 36.2% of the patients presented with a preoperative resp. -procedural H&H grade 2, while grade 1 was observed in 23.5 and grade 3 in 31.6%. Aneurysm size did not have any obvious correlation to the H&H grade at admission (p=0477). 48.7% of the patients were admitted with Fisher grade IV, while 35% presented with Fisher grade III, and 2.2 resp. 3% presented with a Fisher grade II and I. Aneurysms of ≤5mm had a significantly lower rate of Fisher grade IV bleedings 40.2 versus 65.7%, p=0.000282). Aneurysms >5mm tended however to have a higher risk of recurrent rupture (7.8% versus 2.6% for aneurysms ≤5mm) the difference was however not significant (p=0.063). 57% of the aneurysms were treated by endovascular procedures and 43% by surgical clipping. Treatment modality was however found to have less influence the outcome than initial H&H or Fisher grade.
Conclusions: While the presented data is not suitable to assess the rupture risk of aneurysms, we found that a high percentage of the SAH cases treated in our institution had bled from small aneurysms (diameter 1-5mm). We therefore conclude that also small aneurysms are a potentially dangerous condition. Therefore we suggest that possible treatment options should be carefully considered also in small incidental aneurysms.
