gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Does multidisciplinary treatment of ruptured cerebral aneurysms with significant surgical contribution offer better outcomes? A single centre experience

Meeting Abstract

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  • Catia Gradil - King’s College Hospital, Department of Neurosurgery, London, United Kingdom
  • Peter Birkeland - King’s College Hospital, Department of Neurosurgery, London, United Kingdom
  • John Ling - King’s College Hospital, Department of Neurosurgery, London, United Kingdom
  • Maria de Abreu - King’s College Hospital, Department of Neurosurgery, London, United Kingdom
  • Ruth-Mary Desouza - King’s College Hospital, Department of Neurosurgery, London, United Kingdom
  • Daniel Walsh - King’s College Hospital, Department of Neurosurgery, London, United Kingdom
  • Christos Tolias - King’s College Hospital, Department of Neurosurgery, London, United Kingdom

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.05.04

doi: 10.3205/17dgnc027, urn:nbn:de:0183-17dgnc0275

Published: June 9, 2017

© 2017 Gradil et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: In 2007 we published the early post ISAT neurovascular experience of our unit. Since then, the management of intracranial aneurysms has evolved as individual neurosurgical centres adopt different multidisciplinary approaches in the management of these complex patients. The role of open surgery remains debatable and evolving. We hypothesize that overall recurrence rates of treated aneurysms in our unit to be favoured by the relative contribution of the significant number of surgically managed cases.

Methods: In this retrospective observational study we analyse the demographics of patients with ruptured brain aneurysms admitted to King´s College Hospital between January 2007 and December 2013. Data include WFNS and Fisher grading of SAH, time elapsed from ictus to admission and from admission to treatment, location and size of aneurysm, treatment modalities as well as recurrence and rebleed rates.

Results: Overall, 693 consecutive cases of SAH were admitted. For all patients management followed a multidisciplinary decision process. Majority of cases were WFNS grades I and II SAH following rupture of anterior circulation aneurysms ranging 2mm to 48mm in size. Of the 177 cases in which open surgery was performed, the majority entailed clipping, and less frequently bypass reconstructive surgery for complex aneurysms. The endovascular group consisted of 471 cases and 45 cases needed more than one treatment modality. Our outcomes were amongst the best in the country (30-day mortality), with 6 month GOS not different from the average (NNAP and UK National SAH database). However, the overall population recurrence and retreatment rates were less than expected. The recurrence rate was found to be greater amongst patients within the endovascular treatment subgroup.

Conclusions: We conclude that a multidisciplinary decision process, offering a full complement of endovascular and neurosurgical expertise for the treatment of intracranial aneurysms, as well as a close follow-up, are determinant factors in achieving the best possible outcomes. Such approach appears to continue to recognize surgical treatment as a competitive modality in achieving good and lasting results.