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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

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Primary epileptogenic unruptured intracranial aneurysms – incidence and treatment implications

Meeting Abstract

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  • D. Hänggi - Neurochirugische Klinik, Heinrich-Heine-Universität Düsseldorf
  • P. Winkler - Neurochirurgische Klinik, Ludwig-Maximilian-Universität, München
  • H.-J. Steiger - Neurochirugische Klinik, Heinrich-Heine-Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP13-05

doi: 10.3205/09dgnc391, urn:nbn:de:0183-09dgnc3918

Published: May 20, 2009

© 2009 Hänggi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Seizures as initial manifestation of unruptured intracranial aneurysms are rare. It is unclear whether seizures forebode a risk of subsequent rupture and how these aneurysms are best treated to control epilepsy.

Methods: Out of a series of 85 unruptured aneurysms in patients without previous subarachnoid hemorrhage, 7 patients exclusively presented with epileptic seizures. In 3 of them a highly situated internal carotid artery aneurysm was diagnosed that was buried in the parahippocampal gyrus. In 2 patients middle cerebral artery aneurysms likewise created a conflict with the medial temporal lobe adjacent to the parahippocampal gyrus. An anterior communicating and a pericallosal artery aneurysm were diagnosed in 2 further patients. Initially, the 2 MCA aneurysms were incompletely occluded with GDC coils, without an effect on the aneurysm. In all but one patient the aneurysm was finally clipped and completely removed.

Results: Intraoperatively there were no signs of hemorrhage but of cortical gliosis around the dome of the aneurysm, which was also removed surgically. Freedom from seizures without medication resulted in all cases after microsurgical operation.

Conclusions: Seizures as a presenting symptom of unruptured intracranial aneurysms are rare. Seemingly there exists a preponderance of aneurysms anatomically related to the temporomesial region. Elimination of the aneurysm and of perifocal gliosis promises cure of the epilepsy.