gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Evaluation of the surgical versus endovascular treatment of ruptured and unruptured pericallosal aneurysms – an international multicentric study

Bewertung der chirurgischen versus endovaskulären Behandlung der pericallosal Anevrismen, ruptuiert und nicht ruptuiert: eine internationale Studie

Meeting Abstract

  • presenting/speaker Julien Haemmerli - Hopitaux Universitaires de Genève, Klinik und Poliklinik für Neurochirurgie, Genf, Schweiz
  • Anatoliy Bervitskiy - The “Federal Centre of Neurosurgery” of the Ministry of health of the Russian Federation Novosibirsk, Department of Neurosurgery, Novosibirsk, Russische Föderation
  • Elena Kurz - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
  • Justin Turpin - Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Department of Neurosurgery, Manhasset, NY, Vereinigte Staaten
  • Torstein R. Meling - Hopitaux Universitaires de Genève, Klinik und Poliklinik für Neurochirurgie, Genf, Schweiz
  • Amir R. Dehdashti - Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Department of Neurosurgery, Manhasset, NY, Vereinigte Staaten
  • Florian Ringel - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
  • Jamil Rzaev - The “Federal Centre of Neurosurgery” of the Ministry of health of the Russian Federation Novosibirsk, Department of Neurosurgery, Novosibirsk, Russische Föderation
  • Karl Schaller - Hopitaux Universitaires de Genève, Klinik und Poliklinik für Neurochirurgie, Genf, Schweiz
  • Philippe Bijlenga - Hopitaux Universitaires de Genève, Klinik und Poliklinik für Neurochirurgie, Genf, Schweiz

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV104

doi: 10.3205/22dgnc106, urn:nbn:de:0183-22dgnc1063

Published: May 25, 2022

© 2022 Haemmerli 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: Treatment of pericallosal aneurysms (PeriAy), whether endovascular or surgical, relies more on the neurovascular team experience than on evidence-based guidelines. This study aims to compare endovascular and surgical treatments of PeriAy, ruptured and unruptured.

Methods: All data were extracted from the Pericallosal Aneurysm Study Group data base, an multicentric international cohort collecting data on patients treated for at least one PeriAy, ruptured and unruptured. Outcomes were compared by endovascular versus surgical treatments, and by rupture status. The primary outcome was the mRS at 12 months. Secondary outcomes were the aneurysmal complete occlusion at 12 months, the rate of complications, and vasospasms requiring invasive treatment.

Results: One hundred and sixteen treated pericallosal aneurysms were included, 31 (26.7%) were treated endovascularly and 85 (73.3%) were treated surgically. Fifty-three treatments concerned ruptured PeriAy (21 endovascular (67.7%), 32 surgical (37.6%) (p<0.001)). Demographics were similar between groups. No difference regarding the mRS at 12 months was observed between the treatment groups (endovascular and surgical groups respectively (median): all 0 [Q1:0, Q3:2], 0 [Q1:0, Q3:1]; unruptured 0 [Q1:0, Q3:1], 0 [Q1:0, Q3:1]; ruptured 0 [Q1:0, Q3:2], 0 [Q1:0.5, Q3:2]).No residual perfusion of the PeriAy was observed in the surgical treatment group, whereas 44.4% of the endovascularly-treated aneurysms were found to have residual perfusion (p<0.001). The need of invasive treatment for vasospasm was significantly lower in the surgical group (12.5%) compared to the endovascular group (38.1%, p=0.04). No difference was observed regarding the complication rate (endovascular 29%, surgical 16.5%, p=0.19).

Conclusion: Although surgical treatment reduces the risk of aneurysmal residual perfusion and the need of invasive treatment for vasospasms, ruptured PeriAy are more often treated endovascularly. PeriAy should be considered for surgical treatment, especially if ruptured. Endovascular treatment should be reserved for morbid patients with surgical risk. Multicentric data collection is still ongoing.