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

Surgical treatment of unruptured middle cerebral artery bifurcation aneurysms – long-term retrospective single-centre study

Mikrochirurgische Behandlung von unrupturierten Arteria cerebri media Bifurkationsaneurysmen – eine retrospektive monozentrische Langzeitstudie

Meeting Abstract

  • presenting/speaker Matthias Gmeiner - Johannes Kepler University, Neurosurgery, Linz, Österreich
  • Nico Stroh - Johannes Kepler University, Neurosurgery, Linz, Österreich
  • Michael Giretzlehner - RISC Software, Research Unit Medical Informatics, Hagenberg, Österreich
  • Philipp Hermann - Johannes Kepler University, Center for Clinical Studies (CCS Linz), Linz, Österreich; Johannes Kepler University, Institut of Applied Statistics, Linz, Österreich
  • Helga Wagner - Johannes Kepler University, Center for Clinical Studies (CCS Linz), Linz, Österreich; Johannes Kepler University, Institut of Applied Statistics, Linz, Österreich
  • Maria Gollwitzer - Johannes Kepler University, Neurosurgery, Linz, Österreich
  • Gracija Sardi - Johannes Kepler University, Neurosurgery, Linz, Österreich
  • Andreas Gruber - Johannes Kepler University, Neurosurgery, Linz, Österreich

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. DocV271

doi: 10.3205/21dgnc257, urn:nbn:de:0183-21dgnc2571

Veröffentlicht: 4. Juni 2021

© 2021 Gmeiner 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: Microsurgical clipping of middle cerebral artery aneurysms (MCA) has traditionally been regarded as a standard treatment. Recently, a caseload reduction related to improved endovascular treatment options has occurred in cerebrovascular neurosurgery. Therefore, studies reporting the clinical and radiological long-term outcomes after clipping are highly warranted.

Methods: Patients with an unruptured MCA bifurcation aneurysm, who were surgically treated between 2002-October 2019, were included. In each patient the surgical strategy and clinical as well as radiological outcome was retrospectively determined. Logistic regression analyses were conducted in order to identify possible effects of clinical and demographic variables on several main and secondary target criteria related to complication.

Results: Overall 272 consecutive patients were included (mean age at operation 55 years, range 18-79 years). 270 patients were successfully clipped (mean aneurysm diameter: 5.8mm, range 2-25mm; 1-8 clips per patient) with an additional wrapping performed in six patients. Complete aneurysm occlusion was demonstrated in 252 patients (92.7%) using postoperative digital subtraction angiography in 254 patients (93.4%). Intraoperative rupture occurred in eight patients. In six patients (2.2%) a permanent neurological deficit persisted after treatment. At the last follow up only two of these six patients had an unfavorable outcome (modified ranking scale 3-5). In logistic regression analysis a significant effect of intraoperative rupture (p=0.049) on a permanent neurological deficit was estimated. Further, the risk of neurological deficits decreased significantly over time meaning that patients who were operated at a later time point suffered less often from a permanent neurologic deficit (p=0.009). Two patients died (0.7%) perioperatively (fatal fulminant sepsis versus pulmonary embolism). Two patients were retreated approximately 6 and 14 years after initial clipping surgery, of whom one patient presented with subarachnoid hemorrhage.

Conclusion: In this long-term retrospective study the morbidity and mortality rates were estimated to be very low when microsurgical clipping was performed. Especially retreatment rates were found to be low. Therefore, mircrosurgical clipping remains an adequate treatment strategy in patients with unruptured MCA aneurysms.