gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Artikel

Artikel empfehlen

Current status of the Giant Intracranial Aneurysm Registry – natural history and outcome of endovascular or surgical management

Aktueller Stand des Intrakraniellen Riesenaneurysmaregisters – natürlicher Verlauf und Ergebnisse der endovaskulären oder operativen Therapie

Meeting Abstract

Suche in Medline nach

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

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP122

doi: 10.3205/19dgnc458, urn:nbn:de:0183-19dgnc4582

Veröffentlicht: 8. Mai 2019

© 2019 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 rare lesions that display the poorest treatment outcomes of all intracranial aneurysms (IA). The international GIA Registry was initiated as a dedicated health services project in 2008, dealing exclusively with GIA. Its main goal is to document current treatment strategies and report on the natural history and treatment outcomes for ruptured (rGIA) and unruptured GIA (uGIA).

Methods: In the now completed enrolment phase, patients were included prospectively and retrospectively at 36 interdisciplinary centers throughout Europe, Japan and the US. The only inclusion criterion is an IA with a diameter of at least 25 mm. Clinical and radiological features are documented over 5 years of follow-up, especially in relation to conservative management (CM), endovascular management (EM) and surgical management (SM). At the DGNC meeting in 2018, we presented the first results from the prospective cohort. We are now able to present data from the completed retrospective cohort.

Results: Between January 2006 and November 2016, 219 GIA from 28 centers were included in the retrospective cohort. At baseline, 171 GIA (78.1%) were uGIA and 48 (21.9%) rGIA. In uGIA, patients undergoing EM were older (60.0 y; IQR 53.0–67.0) than those in the SM cohort (53.0 y; IQR 45.0–64.0; p=0.01). In the EM cohort, posterior circulation GIAs were more frequent than in the SM cohort, both in rGIA (p=0.03) and in uGIA (p<0.01). In uGIA, the median mRS was higher in the EM cohort (3; IQR 1–4) than in SM (1; IQR 0–2; p<0.01). There were no differences in GIA diameters between CM, EM or SM. At a mean follow-up of 4.8 years (SD 2.2), case fatality in rGIA was 100% (8/8) in the CM group, 64.7% (11/17) in the SM group and 57.1% (8/14) in the EM group. In patients with uGIA, case fatality was 75.0% (15/20) in the CM group, 14.3% (4/28) in the SM group and 19.2% (21/104) in the EM group. The risk ratio for death after CM, compared to EM and SM, was 1.63 (95% CI: 1.23–2.16) in rGIA and 3.96 (95% CI 2.57–6.11) in uGIA.

Conclusion: The results from the retrospective cohort of the GIA registry generally confirm those observed in the prospective cohort, which were presented at the 2018 DGNC meeting in Münster. In the CM cohort, all patients with rGIA and 75% of those with uGIA died, while case fatalities in the EM and SM cohorts were substantially reduced. Upcoming results from the prospective cohort will shed light on how the natural history and treatment results further develop over time.