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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Natural history and treatment outcomes of ruptured and unruptured giant intracranial aneurysms – 1-year results from the giant intracranial aneurysm registry

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  • Julius Dengler - Charité - Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Daniel Rüfenacht - Klinik Hirslanden, Zentrum für Neuroradiologie, Zürich, Schweiz
  • Veit Rohde - Georg-August-Universität Göttingen, Department of Neurosurgery, Göttingen, Deutschland
  • Bernhard Meyer - Technische Universität München, Klinikum rechts der Isar, Klinik für Neurochirurgie, München, Deutschland
  • Matthias Endres - Charité - Universitätsmedizin Berlin, Klinik für Neurologie, Berlin, Deutschland
  • Pavlina Lenga - Charité - Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Konstantin Uttinger - Universitätsklinikum Würzburg, Institut für Klinische Epidemiologie und Biometrie, Würzburg, Deutschland
  • Viktoria Rücker - Universitätsklinikum Würzburg, Institut für Klinische Epidemiologie und Biometrie, Würzburg, Deutschland
  • Maria Wostrack - Technische Universität München, Klinikum rechts der Isar, Klinik für Neurochirurgie, München, Deutschland
  • Adisa Kuršumović - DONAUISAR Klinik Deggendorf, Klinik für Neurochirurgie und interventionelle Neuroradiologie, Deggendorf, Deutschland
  • Bujung Hong - Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
  • Dorothee Mielke - Georg-August-Universität Göttingen, Department of Neurosurgery, Göttingen, Deutschland
  • Nils Ole Schmidt - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
  • Philippe Bijlenga - Hopitaux Universitaire de Genève, Department of Neurosurgery, Genf, Schweiz
  • Eduardo Boccardi - Metropolitan Hospital Niguarda, Department of Neuroradiology, Mailand, Italien
  • Christophe Cognard - University Hospital Toulouse, Department of Neuroradiology, Toulouse, Frankreich
  • Peter U. Heuschmann - Universitätsklinikum Würzburg, Institut für Klinische Epidemiologie und Biometrie, Würzburg, Deutschland
  • Peter Vajkoczy - Charité - Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocV007

doi: 10.3205/18dgnc007, urn:nbn:de:0183-18dgnc0079

Veröffentlicht: 18. Juni 2018

© 2018 Dengler et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: Giant intracranial aneurysms (GIA) are known for the highest risk of rupture and the highest mortality rates of all intracranial aneurysms. Since GIA are a rare disease condition, there is limited evidence on them. We aim to examine the natural history and treatment outcomes of ruptured (rGIA) and unruptured GIA (uGIA).

Methods: The GIA registry is a prospective multicenter observational study exclusively focusing on GIA, which are defined as intracranial aneurysms with a diameter of at least 25 mm. Patients with rGIA and uGIA admitted to one of the 32 participating centers in Europe, Japan and the US were included. We present 1-year results for rupture rates and survival during the course of the natural history and for outcomes of surgical and endovascular management.

Results: Between December 2008 and February 2017, we included 362 subjects with 300 (82.9%) uGIA and 62 (17.1%) rGIA. Surgical management of rGIA / uGIA was performed in 33.9% / 30.0%, endovascular management in 38.7% / 48.0% and the natural history was followed in 27.4% / 22.0%, respectively. During the natural history of uGIA, we observed 1-year rupture rates of 21.6% for the entire cohort and 25.3% after exclusion of uGIA at the cavernous ICA. 1-year survival rates during the natural history of rGIA / uGIA was 0.0% / 78.0%. Significantly higher 1-year survival rates were found after endovascular (rGIA: 61.0% / uGIA: 88.0%) or surgical management (rGIA: 64.0% / uGIA: 97.0%). In rGIA, 1-year survival was associated with WFNS, GCS, mRS and the presence of cranial nerve deficits at baseline. In uGIA, the hazard ratio (HR) for death for 1 year in subjects between 65-74 years was 5.1 (95% CI: 1.4-19.0) and that of subjects older than 74 ears was 7.6 (95% CI: 2.0-28.4; p<0.01) compared to subjects younger than 55 years. HR for death for 1 year in subjects with posterior circulation GIA was 6.7 (95% CI: 1.5-30.4; p<0.01) with patients with GIA located at the non-cavernous ICA as reference. There was no statistically significant association between uGIA size and 1-year mortality.

Conclusion: In our patient cohort, the natural history of uGIA at 1 year of follow-up produced rupture rates of 25.3% and a 21.6% mortality rate. Already within the first year of follow-up, outcomes of endovascular or surgical management were significantly superior compared to the natural history, both for rGIA and uGIA. The risk of death at 1 year in uGIA was highest in patients older than 65 years with posterior circulation GIA.