Short- and midterm outcome of ruptured and unruptured intracerebral wide-necked aneurysms with microsurgical treatment
Open Access
- 2 March 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Scientific Reports
- Vol. 11 (1), 1-11
- https://doi.org/10.1038/s41598-021-84339-x
Abstract
To clip or coil has been matter of debates for several years and is the domain of interdisciplinary decision making. However, the microsurgical outcome has still been elusive concerning wide neck aneurysms (WNA). A retrospective single center study was performed with all patients with ruptured WNA (rWNA) and unruptured WNA (uWNA) admitted to author´s institute between 2007–2017. Microsurgical outcome was evaluated according to Raymond-Roy occlusion grade and follow-up angiography was performed to analyze the stability of neck/aneurysm remnants and retreatment poverty. Of 805 aneurysms, 139 were rWNA (17.3%) and 148 uWNA (18.4%). Complete occlusion was achieved in 102 of 139 rWNA (73.4%) and 112 of 148 uWNA (75.6%). Neck remnants were observed in 36 patients with rWNA (25.9%) and 30 patients with uWNA (20.3%), 1 (0.7%) and 6 (4.1%) patients had aneurysmal remnant, respectively. Overall complication rate was 11.5%. At follow-up (939/1504 months), all remnants were stable except for one, which was further conservatively treated with marginal retreatment rate under 1%. Even the risk of de-novo aneurysm was higher than the risk for remnant growth (2.6% vs 0% in rWNA; 8.7% vs 5.3% in uWNA) without significant difference. Microsurgical clipping is effective for complete occlusion of r/uWNA with low complication. Furthermore, the risk of remnant growth is marginal even lower than the risk of de-novo rate low retreatment rate.Funding Information
- Johann Wolfgang Goethe-Universität, Frankfurt am Main
This publication has 22 references indexed in Scilit:
- Rapid ventricular pacing for clip reconstruction of complex unruptured intracranial aneurysms: results of an interdisciplinary prospective trialJournal of Neurosurgery, 2018
- Efficacy and Safety of the Woven EndoBridge (WEB) Device for the Treatment of Intracranial Aneurysms: A Systematic Review and Meta-AnalysisAmerican Journal of Neuroradiology, 2016
- Clinical and Anatomical Follow-up in Patients With Aneurysms Treated With the WEB DeviceNeurosurgery, 2016
- The Barrow Ruptured Aneurysm Trial: 6-year resultsJournal of Neurosurgery, 2015
- Intrasaccular Flow Disruption in Acutely Ruptured Aneurysms: A Multicenter Retrospective Review of the Use of the WEBAmerican Journal of Neuroradiology, 2015
- The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT)The Lancet, 2014
- The Barrow Ruptured Aneurysm Trial: 3-year resultsJournal of Neurosurgery, 2013
- WEB Device for Endovascular Treatment of Wide-Neck Bifurcation AneurysmsAmerican Journal of Neuroradiology, 2013
- International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trialThe Lancet, 2002
- Endovascular Treatment of Unruptured AneurysmsStroke, 2001