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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Surgical outcome of wide neck aneurysm, part 1 – ruptured aneurysm

Chirurgisches Outcome der breitbasigen Aneurysmen, Part 1 – Rupturierte Aneurysmen

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  • presenting/speaker Sae-Yeon Won - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Daniel Dubinski - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Nazife Dinc - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Nina Brawanski - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Volker Seifert - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Joachim Berkefeld - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Jürgen Konczalla - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt am Main, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV116

doi: 10.3205/19dgnc122, urn:nbn:de:0183-19dgnc1221

Published: May 8, 2019

© 2019 Won 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

Text

Objective: To clip or coil has been matter of debates for several years and is the domain of interdisciplinary decision making. Regarding wide neck aneurysm (WNA), there has been several studies presenting outcome of endovascular treatment, however, the surgical outcome has still been elusive. The aim of the study was to evaluate surgical outcome of ruptured WNA (rWNA) to refine the comparability of different treatment options.

Methods: This study was conducted with patients surgically treated on a rWNA from 2007 to 2017 in author’s institute. WNA was defined as either neck diameter ≥ 4mm or neck-to-dome ratio <2. Surgical outcome was evaluated by a digital subtraction angiography (DSA) postoperatively and long term outcome was evaluated by DSA or MR-angiography. Neurological outcome was determined by modified Ranking Scale (mRS) at 6 months’ follow-up.

Results: Of 139 rWNA, 93 patients were female (66.9%) with median age of 52 years (range 2-83). About half of those patients were in good admission status. Surgically complete occlusion was achieved in 102 of 139 (73.4%), neck remnants were detected in 36 of 139 patients (25.9%) and one patient (0.7%) had a residual aneurysm, which was conservatively controlled at follow-up. All in all, volume reduction of WNA was postoperatively achieved up to 85%. At follow-up (939 follow-up months), no recurrent aneurysm was detected and all neck remnants and residual aneurysm were stable without any sign of growths at mean follow-up of 29.9±28.2 months. Furthermore, one de-novo aneurysm (2.6%) was detected in the media artery. There were three independent predictors identified for surgical WNA-remnants: early hydrocephalus (OR 3.2), irregular configuration of WNA (OR 2.) and number of clips more than one (OR 3.0). Favorable outcome was achieved in 75 patients (56%) at 6 months’ follow-up.

Conclusion: After surgical treatment of rWNA, a high number has a complete occlusion. Furthermore, at short- and long-term follow-up one de-novo aneurysm but no further aneurysm growth was detected.