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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Cerebral lesions after endovascular and surgical treatment of unruptured intracranial aneurysms of the anterior circulation

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  • Erdem Güresir - Klinik für Neurochirurgie, Goethe Universität Frankfurt am Main, Frankfurt am Main
  • Hartmut Vatter - Klinik für Neurochirurgie, Goethe Universität Frankfurt am Main, Frankfurt am Main
  • Patrick Schuss - Klinik für Neurochirurgie, Goethe Universität Frankfurt am Main, Frankfurt am Main
  • Johannes Platz - Klinik für Neurochirurgie, Goethe Universität Frankfurt am Main, Frankfurt am Main
  • Jürgen Konczalla - Klinik für Neurochirurgie, Goethe Universität Frankfurt am Main, Frankfurt am Main
  • Richard du Mesnil de Rochement - Klinik für Neuroradiologie, Goethe Universität Frankfurt am Main, Frankfurt am Main
  • Joachim Berkefeld - Klinik für Neuroradiologie, Goethe Universität Frankfurt am Main, Frankfurt am Main
  • Volker Seifert - Klinik für Neurochirurgie, Goethe Universität Frankfurt am Main, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.16.05

doi: 10.3205/13dgnc142, urn:nbn:de:0183-13dgnc1426

Published: May 21, 2013

© 2013 Güresir et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: Ischemic events are known complications of endovascular and surgical treatment of intracranial aneurysms. However, data on the incidence of treatment associated ischemic lesions after surgical and endovascular treatment of unruptured intracranial aneurysms (UIAs) is missing so far. We therefore performed a prospective study analysing the incidence of ischemic lesions after treatment of UIA of the anterior circulation.

Method: Between April 2011 and December 2012, 78 UIAs of the anterior circulation were treated by clipping, and 27 by endovascular coiling. All patients underwent magnetic resonance imaging (MRI) before, and after aneurysm treatment. Ischemic lesions were divided into silent, and symptomatic. Outcome was assessed according to the modified Rankin scale one day after as well as 3 months after treatment.

Results: Overall, treatment associated ischemic lesions were found in 17 of the 78 patients (22%) treated surgically, and in 14 of the 27 patients (52%) treated endovascularly (p=0.006, RR 2.4, 95% CI 1.4 - 4.1). Of these lesions, 4 (5%) were symptomatic in the surgical group and 3 (11%, p=0.4) in the endovascular group in the immediate follow-up. After 3 months, none of the patients showed major deficits. One patient in the surgical as well as one patient in the endovascular group had recovered almost completely from a slight arm paresis.

Conclusions: The present data indicates that the risk of silent ischemic events during treatment of UIAs of the anterior circulation is higher after coiling compared to clipping. However, the rate of symptomatic lesions does not differ between both groups. Therefore microsurgical clipping remains to be a safe and durable treatment option in the tretament of UIAs.