gms | German Medical Science

Objective: There are various data about the incidence of aneurysm development and when they occur during live time. In the present study we focused on the occurrence of new aneurysms in patients which were already treated for intracranial aneurysms.

Methods: Retrospective study on patients treated in our department form 2000–2011 and followed up until November 1st 2017. CTA and MRA during follow up visits were evaluated and analysed for de novo aneurysms as well as reperfusion on the treated aneurysms. Risk factors like hypertonia and nicotine were evaluated in respect to aneurysm formation.

Results: 130 patients with intracranial aneurysm treatment were analysed. 63 patients received microsurgical clipping and 67 had endovascular coiling.MCA aneurysms were treated microsurgically and basilar aneurysms were treated endovascularlly. The rest of the aneurysms treated microsurgically or endovascularly in about 50% of cases. Nicotine and hypertonia were equally distributed between the groups. De novo aneurysms occurred in 10 / 130 patients (7,6 %) in a mean time of 7,9 ±2,9 years. There was no association of de novo aneurysms and localisation of the treated aneurysms, nicotine, hypertonia or gender. Re-perfusion occurred in just 2/63 (3,1%) cases treated microsurgically and in 26/67 (38,8%) cases treated endovascularlly. One of these re-perfused and coiled aneurysms bled (1/26, 3,8 %). AcomA and basilar aneurysms had a re-perfusion rate of 32% and 50% respectively. The mean time of reperfusion was 3,82 ± 3,3, years. The complication rate of microsurgical treatment was 11,2% (infarctions and bleeding) and of endovascular treatment 5,9% (infarctions).

Conclusion: The occurrence of de novo aneurysms in patients already diagnosed with one or more aneurysms is 7,6% in 8 years, stressing out the importance of long follow up in these patients. The complication rate of microsurgical treatment is higher compared to endovascular treatment by about 2x. However, the reperfusion rate of endovascularly treated aneurysms was(12x). Irrespective of the higher complication rate in microsurgical treatment the overall procedural risk is higher in endovascular treatment. We could assume a reperfusion of endovascularly treated aneurysms in 4 years in 1/3 of patients with a bleeding risk of these aneurysms of 1 in 300 patient years. Therefore we follow a policy of microsurgical treatment in patients younger than 40 y.o. when the aneurysm is surgically or endovascularly approachable.