Publikation

Surgical treatment of unruptured intracranial aneurysms in a low-volume hospital--outcome and review of literature

Wissenschaftlicher Artikel/Review - 01.02.2012

Bereiche
PubMed
DOI

Zitation
Seule M, Stienen M, Gautschi O, Richter H, Desbiolles L, Leschka S, Hildebrandt G. Surgical treatment of unruptured intracranial aneurysms in a low-volume hospital--outcome and review of literature. Clin Neurol Neurosurg 2012; 114:668-72.
Art
Wissenschaftlicher Artikel/Review (Englisch)
Zeitschrift
Clin Neurol Neurosurg 2012; 114
Veröffentlichungsdatum
01.02.2012
eISSN (Online)
1872-6968
Seiten
668-72
Kurzbeschreibung/Zielsetzung

BACKGROUND
The aim of this study was to evaluate surgical outcome of unruptured intracranial aneurysms (UIAs) in a low-volume hospital and compare the results with the recent literature.

METHODS
A retrospective review of all consecutive craniotomies for UIA from July 1999 through June 2009 was performed. Morbidity was defined as modified Rankin Scale (mRS) ≥ 3 and evaluated six weeks after surgery. Cognitive function was evaluated at rehabilitation-to-home discharge. A PubMed database search (2001-2011) seeking retrospective, single-center studies reporting on surgical outcome of UIAs was performed.

RESULTS
There were 47 procedures performed in 42 patients to treat 50 UIAs (mean of 5 annual craniotomies). The mean age was 54.7 ± 12.1 years and mean aneurysm size was 7.6 ± 4.0mm. Favorable outcome (mRS 0-2) at six weeks after surgery was achieved in 45 of 47 procedures (95.7%). Aneurysm size ≥ 12 mm was statistically significant related to adverse outcome defined as mRS change ≥ 1 (71% vs. 29%; p = 0.018). Five patients (10.6%) with favorable neurological outcome (mRS 2) presented with cognitive impairment at rehabilitation-to-home discharge. There was no significant difference in overall morbidity and mortality comparing low- and high-volume hospitals (4.0% vs. 4.8%; p = 0.85).

CONCLUSIONS
Low-volume hospitals may achieve good results for surgical treatment of UIAs. The results indicate that defining numeric operative volume thresholds is not feasible to guide centralization of aneurysm treatment.