Article
Clipping of cerebral aneurysms without acute subarachnoid hemorrhage – Outcome analysis of 100 consecutive cases from an academic teaching hospital
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Authors
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Andreas Jödicke
- Klinik für Neurochirurgie, Vivantes Klinikum Neukölln, Berlin, Germany
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Karsten Bauer
- Klinik für Neurochirurgie, Vivantes Klinikum Neukölln, Berlin, Germany
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Andrea Hajduk
- Klinik für Neurochirurgie, Vivantes Klinikum Neukölln, Berlin, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Risk factors for the surgical treatment of unruptured cerebral aneurysms have been identified often based on patient cohorts from university neurosurgical centers. Since microsurgery of aneurysms is performed in neurosurgical departments of different center levels, we analyzed radiological and clinical outcome and risk factors for adverse outcome in a retrospective analysis of our academic teaching hospital department. Since up to 17% long-term care after clipping has been published as an argument in favor of endovascular treatment (McDonald JS et al, Stroke 44, 2013), we analyzed rehabilitation rates.
Method: From July 2007 to September 2013, 100 consecutive patients with at least one cerebral aneurysm were clipped in our Department. Aneurysms were classified as incidental, associated, pre-treated (Coil-compaction post SAH) and symptomatic (oculomotor-compression, micro-emboli) and assigned to their anatomical location. Complications (infection, hemorrhage, CSF fistula, transient and permanent neuro-deficit, re-operation) and outcome (mRS at 6 months; postoperative DSA) were correlated. Multiple aneurysms clipped in one procedure were not counted separately regarding complications or outcome (i.e. one patient, one outcome). Also, frequency and type of rehabilitation was analyzed.
Results: The overall complication rate was 15% with 8% transient, 4% permanent neuro-deficit and 7% reoperation. There was not death. 95,7% of patients had a good outcome (mRS 0-2), 4,3% mRS3. Clip occlusion rate (DSA) was 96,9%. Nominal logistic regression analysis identified aneurysm location (not pre-treatment or age) as the only significant factor for risk of complication (p=0.0054). Complication was the predominant prognostic factor for adverse clinical outcome in partition analysis. Rehabilitation was indicated or requested by the patient as early neuro-rehab (5,6%), inpatient follow-up (18%; AHB) and outpatient follow up (12%) with a trend for higher frequency in patients with associated aneurysms.
Conclusions: Radiological and clinical outcome of microsurgery in non-acute aneurysms (including post-coil and associated aneurysms) seem as safe and effective. Long-term care rate is very low.
