gms | German Medical Science

Objective: To evaluate the outcome and surgical risk after innocent intracranial aneurysm surgery.

Methods: We retrospectively evaluated data of a consecutive series of 119 patients who underwent 128 surgeries for one or more innocent intracranial aneurysms.

Results: 119 patients (83 females, 36 males, mean age at surgery 52.6 years) underwent 128 procedures including 121 clippings, 4 wrappings, one trapping, one aneurysm excision with end-to-end anastomosis and one STA to MCA EC-IC bypass additionally to clipping of a giant left sided MCA aneurysm in an awake brain surgery procedure. In 9 cases two or more aneurysms were clipped within one procedure. Most aneurysms were discovered incidentally and the patients had no (29) or unrelated (64) symptoms or diseases. 14 patients were diagnosed within a subarachnoid hemorrhage of a different ruptured aneurysm before. Three patients showed symptoms of nerve or brain compression (one at the brain stem, one in the internal acoustic meatus, mimicking a vestibular schwannoma and one via compression of the optic nerve). Aneurysm location (138 aneurysms) included MCA (75), Acom (20), ICA (21), PCA (3), SCA (3), PICA (2), AntChoroidal (2), ophthalmic (2), pericallosa (3), ACA (3), Pcom (3) and AICA (1). There was no intraoperative aneurysm rupture. 13 patients with 14 aneurysm surgeries were lost to follow-up. Postoperative angiographic control of the treated aneurysms showed a complete occlusion in 103 cases (90.4%) and minor aneurysm remnants in 4 patients. Major remnants were seen in 7 patients (6 expected as 5 of them underwent aneurysm wrapping, 1 unexpected). Two clips were revised. One patient with an Acom-aneurysm died of a remote midbrain and pons hemorrhage; two other patients (one Acom and one MCA aneurysm) had a remote cerebellar hemorrhage without permanent symptoms. One patient with an Acom aneurysm, who could not successfully be coiled before, died of a malignant bifrontal infarction after clipping. Permanent deficits included two cases with hemiparesis (one in a patient with aneurysm wrapping occurring 7 weeks after surgery). Transient complications included 5 mild hemipareses, 6 mild aphasias, one seizure with a short resuscitation episode (patient recovered completely), 3 CSF leakages (one revised, two treated with a lumbar drain) and 1 epidural hematoma due to perioperative anticoagulative treatment requiring evacuation. One patient needed evacuation of a chronic subdural hematoma at the 3 months follow-up. In 75.4 % of the cases patients presented no neurological deficits during the perioperative course, 92.1% were discharged without neurological deficits.

Conclusion: Clipping of innocent intracranial aneurysms is a safe procedure providing good neurological outcome and lasting protection from aneurysm rupture.