gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Outcome changes in elective anterior circulation aneurysm surgery over the last two decades due to technical improvements

Veränderung des Outcome in der elektiven chirurgischen Versorgung von Aneurysmen der vorderen Strombahn durch technische Verbesserungen

Meeting Abstract

  • presenting/speaker Sebastian Siller - University Hospital, Ludwig-Maximilian-University Munich, Neurosurgical Clinic, München, Deutschland
  • Patricia Bernasconi - University Hospital, Ludwig-Maximilian-University Munich, Anesthesiologic Clinic, München, Deutschland
  • Mathias Kunz - University Hospital, Ludwig-Maximilian-University Munich, Neurosurgical Clinic, München, Deutschland
  • Julian Schwarting - University Hospital, Ludwig-Maximilian-University Munich, Neurosurgical Clinic, München, Deutschland
  • Jörg-Christian Tonn - University Hospital, Ludwig-Maximilian-University Munich, Neurosurgical Clinic, München, Deutschland
  • Christian Schichor - University Hospital, Ludwig-Maximilian-University Munich, Neurosurgical Clinic, München, Deutschland
  • Jun Thorsteinsdottir - University Hospital, Ludwig-Maximilian-University Munich, Neurosurgical Clinic, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV137

doi: 10.3205/21dgnc129, urn:nbn:de:0183-21dgnc1292

Veröffentlicht: 4. Juni 2021

© 2021 Siller 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: Over the last 20 years, several periprocedural adjuncts for elective surgical aneurysm treatment have been introduced to increase safety and efficacy, notably the spread of intraoperative neurophysiological monitoring in the late-1990s, implementation of ICG-videoangiography (ICG-VAG) in the mid-2000s, and introduction of intraoperative CT-angiography/-perfusion (iCT-A/-P) in the mid-2010s. These technical achievements were accompanied by improved anesthesiologic and standardized OR-procedures. Although the benefit seems intuitively obvious, it has never been shown whether patient outcomes improved in parallel with introducing these techniques.

Methods: Patients undergoing microsurgical clip occlusion for anterior circulation aneurysms between 1999–2018 were included, with IONM routinely used since 1999, ICG-VAG routinely since 2009, and iCT-A/-P since 2016 in selected cases. We analyzed patients’ characteristics, imaging/surgical parameters, treatment-related morbidity, and outcomes, focusing on differences between three distinct cohorts.

Results: 543 patients were included, all treated by a specialized vascular team, which changed over time. 192 patients were operated before 2008 (cohort I). Since 2009, 284 patients were operated with ICG-VAG, but without iCT-A/-P (cohort II), and 67 patients with ICG-VAG and iCT-A/-P (cohort III). While mean age was younger in cohort I (52 vs. 55 resp. 57yrs; p<0.01), there was no difference between the three cohorts concerning gender distribution (m/f: 1/3) and predominant aneurysm location (MCA: 61%, ICA: 19%, AcomA: 20%). Mean aneurysm size was larger in cohort I (9.3 vs. 7.5 resp. 7.0mm; p<0.01). Both the rate of radiologically detected postoperative ischemia (15.6 vs. 12.0 vs. 9.0%) and the rate of postoperative new deficits (12.5 vs. 7.7 vs. 7.5%) were improved in cohort II and III compared to I; however, the differences did not reach significance. Yet, the incomplete aneurysm occlusion rate was significantly improved at last follow-up (mean: 12months) between cohort I and cohort II resp. III (29.7 vs. 16.4 resp. 6.8%; p=0.05). For cohort III, however, radiologically described aneurysm remnants (4 of 67 cases) were only considered clinically relevant in one patient requiring re-surgery.

Conclusion: (Peri)procedural achievements in elective anterior circulation aneurysm surgery seem to have improved surgical outcomes during the past 20 years.