Article
Surgical outcome of wide neck aneurysm, part 1 – ruptured aneurysm
Chirurgisches Outcome der breitbasigen Aneurysmen, Part 1 – Rupturierte Aneurysmen
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Published: | May 8, 2019 |
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Outline
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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.