Publikation
Elective surgery for unruptured intracranial aneurysm in a non-university neurosurgical unit
Konferenzpapier/Poster - 02.06.2010
Seule Martin, Stienen Martin N., Gautschi Oliver, Richter Heiko, Fournier Jean-Yves, Heilbronner Raoul, Hildebrandt Gerhard
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INTRODUCTION: Treating patients with unruptured intracranial
aneurysms (UIAs) depends on the risk of aneurysm rupture compared with the risk of treatment. The goal of this study was to delineate the operative risk from elective surgery in patients with UIAs in a non-university neurosurgical unit.
PATIENTS AND METHODS: Between January 1999 and November 2009 a total of 391 patients with intracranial aneurysms were treated by surgical clipping. Among them 44 patients harbouring 71 UIAs were included in this analysis. Patient data were categorized into conditions leading to the diagnosis of UIAs, aneurysm characteristics and 3-month outcome using the modified Rankin scale (mRS).
RESULTS: The annual caseload of patients with aneurysm surgery
was 36 + 8 per year. A total of 44 patients demonstrated 71 UIAs
with multiple aneurysm location in 36% (n = 16). The mean age was 55 +12 years with a female/male ratio of 3:1. Conditions
leading to diagnosis were history of subarachnoid hemorrhage
(9%), intracranial aneurysm syndrome (9%), evaluation of
headache/vertigo (36%) and others (46%). Sixty-two out of
71 UIAs were treated by clipping (n = 58) or wrapping (n = 4)
procedure. Mean aneurysm size was 7.8 + 3 mm and location was exclusively in the anterior circulation. Outcome three month after elective surgery was evaluated in 39 of 44 patients up to date. Thirty-six patients (92.3%) showed no significant disability (mRS 0-1), two patients (5.1%) showed persistant focal deficits
(mRS 2) and one patient (2.6%) suffered from severe surgery
unrelated contralateral intracerebral hemorrhage leading to
hemiparesis (mRS 4). The perioperative mortality rate was 0%.
CONCLUSIONS: Elective surgery of UIAs can be performed safely with low morbidity and no mortality rate in a non-university hospital. The effect of surgery on cognitive dysfunction has to be evaluated in further studies.