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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Outcome after subarachnoid hemorrhage from giant intracranial aneurysms: a single center series with 27 patients

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  • Jürgen Konczalla - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Nina Brawanski - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Sepide Kahefiolasl - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Nazife Dinc - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Christian Senft - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Joachim Berkefeld - Universitätsklinikum Frankfurt, Institut für Neuroradiologie, Frankfurt am Main, Deutschland
  • Volker Seifert - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocP137

doi: 10.3205/18dgnc478, urn:nbn:de:0183-18dgnc4789

Published: June 18, 2018

© 2018 Konczalla 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: Giant intracranial aneurysms (GIA; size ≥25mm) are rare, they are prone to rerupture and treatment is very challenging. We report our critically analyzed results of these challenging ruptured aneurysms. Additionally, risk factors for unfavorable outcome were identified.

Methods: Patient and aneurysm characteristics, clinical course and treatment results were collected prospectively and analyzed retrospectively including data from patient records and review of imaging findings. Outcome was assed using the modified Rankin scale (favorable 0-2 vs. 3-6 unfavorable) 6 months after subarachnoid hemorrhage (SAH).

Results: Between 1999 and 02/2017 a total of 27 patients had SAH from GIA. Mean age (±SD) was 54±11 years. 20 patients (74%) had poor admission status (WFNS 4+5) and 22 (82%) a Fisher 3 or 4 SAH. 9 patients (33%) had a GIA of the internal carotid artery, 4 of the anterior cerebral artery (15%), 7 of the middle cerebral artery (26%) and 7 in the posterior circulation (26%). 12 patients (44%) were treated microsurgically, 5 patients endovascularly (19%), one patient combined (4%) and 9 patients died prior treatment (33%). 5 patients (19%) developed a shunt-dependent hydrocephalus. 5 patients (19%) achieved a favorable outcome. Predictive factors for unfavorable outcome in univariate analysis were early hydrocephalus and poor admission. Independent predictor for unfavorable outcome in multivariate analysis was only an early hydrocephalus (odds ratio 30). A subgroup analysis of treated patients showed a favorable outcome in 28% of the patients (5 of 18 patients) and the multivariate analysis confirmed early hydrocephalus as predictor.

Conclusion: Treatment of GIA is still challenging and rerupture prior occurred often resulting in a devastating outcome. However, in treated patients a favorable outcome could be achieved in 28% despite a high rate of large intracerebral hemorrhages. Early hydrocephalus was the only independent risk factors for unfavorable outcome in multivariate analysis.