scholarly journals Ruptured and Unruptured Intracranial Aneurysms – Surgical Outcome

1995 ◽  
Vol 22 (3) ◽  
pp. 187-191 ◽  
Author(s):  
Gary A. Dix ◽  
William Gordon ◽  
Anthony M. Kaufmann ◽  
Ian S. Sutherland ◽  
Garnette R. Sutherland
Keyword(s):  
Intracranial Aneurysms ◽  
Surgical Intervention ◽  
Neurological Status ◽  
Postoperative Result ◽  
Third Nerve Palsy ◽  
Unruptured Aneurysms ◽  
Excellent Outcome ◽  
Ruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Elective Repair

AbstractBackgroundThe treatment of unruptured, intracranial aneurysms has been the topic of debate. Although recent studies have advocated surgical intervention for unruptured aneurysms, the risk of such treatment in comparison to outcome from ruptured aneurysms has not been established.MethodThis retrospective study examines the outcome of 134 patients with 179 ruptured and unruptured intracranial, saccular aneurysms treated by a single surgeon.ResultsOf the 98 ruptured aneurysms where early surgical intervention was undertaken (less than 48 hours post hemorrhage), 70 had an excellent outcome, 13 were good, four were moderate, two poor and nine patients died postoperatively. Outcome assessment in these cases was correlated to preoperative neurological status. Patients who presented with unruptured aneurysms fell into two categories: symptomatic and asymptomatic. Seven incidental, asymptomatic aneurysms were clipped concurrently to the surgical isolation of the culprit lesion following subarachnoid hemorrhage without influencing outcome, whilst, for varying reasons, eight unruptured aneurysms were not operated upon. Of the remaining 66 surgically treated, unruptured aneurysms, 64 had an excellent postoperative result, one was good (persisting right incomplete third nerve palsy) and one was moderate (left hemiparesis). Thirteen of these aneurysms were symptomatic, whilst 21 were asymptomatic, multiple aneurysms requiring secondary elective repair and 32 were true incidental aneurysms.ConclusionUnruptured aneurysms less than 25 mm in size may be safely, surgically treated relative to the expected natural history and, certainly, with less risk than operative intervention upon ruptured cerebral aneurysms.

Role of apoptosis in intracranial aneurysm rupture

2004 ◽  
Vol 101 (6) ◽  
pp. 1018-1025 ◽  
Author(s):  
Luigi Pentimalli ◽  
Andrea Modesti ◽  
Andrea Vignati ◽  
Enrico Marchese ◽  
Alessio Albanese ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Superficial Temporal Artery ◽  
Aneurysm Rupture ◽  
Terminal Deoxynucleotidyl Transferase ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Aneurysm Wall ◽  
Unruptured Intracranial Aneurysms ◽  
Fine Print

Object. Mechanisms involved in the rupture of intracranial aneurysms remain unclear, and the literature on apoptosis in these lesions is extremely limited. The hypothesis that apoptosis may reduce aneurysm wall resistance, thus contributing to its rupture, warrants investigation. The authors in this study focused on the comparative evaluation of apoptosis in ruptured and unruptured intracranial aneurysms. Peripheral arteries in patients harboring the aneurysms and in a group of controls were also analyzed. Methods. Between September 1999 and February 2002, specimens from 27 intracranial aneurysms were studied. In 13 of these patients apoptosis was also evaluated in specimens of the middle meningeal artery (MMA) and the superficial temporal artery (STA). The terminal deoxynucleotidyl transferase—mediated deoxyuridine triphosphate nick-end labeling technique was used to study apoptosis via optical microscopy; electron microscopy evaluation was performed as well. Apoptotic cell levels were related to patient age and sex, aneurysm volume and shape, and surgical timing. Significant differences in apoptosis were observed when comparing ruptured and unruptured aneurysms. High levels of apoptosis were found in 88% of ruptured aneurysms and in only 10% of unruptured lesions (p < 0.001). Elevated apoptosis levels were also detected in all MMA and STA specimens obtained in patients harboring ruptured aneurysms, whereas absent or very low apoptosis levels were observed in MMA and STA specimens from patients with unruptured aneurysms. A significant correlation between aneurysm shape and apoptosis was found. Conclusions. In this series, aneurysm rupture appeared to be more related to elevated apoptosis levels than to the volume of the aneurysm sac. Data in this study could open the field to investigations clarifying the causes of aneurysm enlargement and rupture.

scholarly journals Residuals, recurrences and re-treatment after endovascular repair of intracranial aneurysms: A retrospective methodological comparison

2019 ◽  
Vol 26 (1) ◽  
pp. 45-54 ◽  
Author(s):  
Jens J Froelich ◽  
Nicholas Cheung ◽  
Johan AB de Lange ◽  
Jessica Monkhorst ◽  
Michael W Carr ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Medical Records ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Flow Diversion ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Methodological Comparison

Objective Incomplete aneurysm occlusions and re-treatment rates of 52 and 10–30%, respectively, have been reported following endovascular treatment of intracranial aneurysms, raising clinical concerns regarding procedural efficacy. We compare residual, recurrence and re-treatment rates subject to different endovascular techniques in both ruptured and unruptured intracranial aneurysms at a comprehensive state-wide tertiary neurovascular centre in Australia. Methods Medical records, procedural and follow-up imaging studies of all patients who underwent endovascular treatment for intracranial aneurysms between July 2010 and July 2017 were reviewed retrospectively. Residuals, recurrences and re-treatment rates were assessed regarding initial aneurysm rupture status and applied endovascular technique: primary coiling, balloon- and stent-assisted coiling and flow diversion. Results Among 233 aneurysms, residual, recurrence and re-treatment rates were 27, 11.2 and 9.4%, respectively. Compared with unruptured aneurysms, similar residual and recurrence (p > .05), but higher re-treatment rates (4.5% vs. 19%; p < .001) were found for ruptured aneurysms. Residual, recurrence and re-treatment rates were: 13.3, 16 and 12% for primary coiling; 12, 12 and 10.7% for balloon-assisted coiling; 14.9, 7.5 and 4.5% for stent-assisted coiling; 91.9, 0 and 5.4% for flow diversion. Stent-assistance and flow-diversion were associated with lower recurrence and re-treatment rates, when compared with primary- and balloon-assisted coiling (p < .05). Conclusions Residuals and recurrences after endovascular treatment of intracranial aneurysms are less common than previously reported. Stent assistance and flow diversion seem associated with reduced recurrence- and re-treatment rates, when compared with primary- and balloon-assisted coiling. Restrained use of stents in ruptured aneurysms may be a contributing factor for higher recurrence/retreatment rates compared to unruptured aneurysms.

scholarly journals Hospital volume and 1-year mortality after treatment of intracranial aneurysms: a study based on patient registries in Scandinavia

2015 ◽  
Vol 123 (3) ◽  
pp. 631-637 ◽  
Author(s):  
Haakon Lindekleiv ◽  
Ellisiv B. Mathiesen ◽  
Olav H. Førde ◽  
Tom Wilsgaard ◽  
Tor Ingebrigtsen
Keyword(s):  
Intracranial Aneurysms ◽  
Hospital Volume ◽  
Cox Regression ◽  
Patient Registries ◽  
Unruptured Aneurysms ◽  
Risk Of Death ◽  
Ruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Long Term Mortality

OBJECT The object of this study was to examine the relationship between hospital volume and long-term mortality after treatment of intracranial aneurysms. METHODS The authors identified patients treated for intracranial aneurysms between 2002 and 2010 from patient registries of Denmark, Norway, and Sweden, and linked to data on 1-year mortality from the population registry of each country. Cox regression models were used to relate hospital volume to the risk of death and adjusted for potential confounders (age, sex, year of treatment, Charlson comorbidity index, country, and surgical treatment). RESULTS The authors identified 5773 patients with ruptured and 1756 patients with unruptured intracranial aneurysms, treated at 15 hospitals. One-year mortality rates were 15.6% for patients with ruptured aneurysms and 2.7% for patients with unruptured aneurysms. No consistent relationship was found between hospital volume and 1-year mortality for ruptured aneurysms in the unadjusted analyses, but higher hospital volume was associated with increased mortality in the analyses adjusted for potential confounders (hazard ratio [HR] per 10-patient increase 1.04, 95% CI 1.00–1.07). There was a trend toward a lower mortality rate in higher-volume hospitals after treatment for unruptured intracranial aneurysms, but this was not statistically significant after adjustment for potential confounders (HR per 10-patient increase 0.69, 95% CI 0.42–1.10). There were large variations in mortality after treatment for both ruptured and unruptured intracranial aneurysms across hospitals and between the Scandinavian countries (p < 0.01). CONCLUSIONS The findings in this study did not confirm a relationship between higher hospital volume and reduced long-term mortality after treatment of ruptured intracranial aneurysms. Prospective registries for evaluating outcomes after aneurysm treatment are highly warranted.

Simulation of the natural history of cerebral aneurysms based on data from the International Study of Unruptured Intracranial Aneurysms

2006 ◽  
Vol 104 (2) ◽  
pp. 188-194 ◽  
Author(s):  
Han Soo Chang
Keyword(s):  
Natural History ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
International Study ◽  
Medical Decision ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Median Diameter ◽  
History Of

Object Despite recent publications of large-scale study data, controversy over the management of unruptured cerebral aneurysms continues. The low rupture rates in the International Study of Unruptured Intracranial Aneurysms (ISUIA) apparently contradicted surgeons’ experiences with ruptured aneurysms. In the present study, based on data from the ISUIA, a mathematical model describing the natural history of cerebral aneurysms was developed. With this model, the author aimed to examine the validity of data from the ISUIA and to provide a better treatment guideline for unruptured aneurysms. Methods The author made a computer simulation of the natural history of cerebral aneurysms that was used to calculate such figures as the prevalence of unruptured aneurysms, incidence of subarachnoid hemorrhage (SAH), and age and size distribution of both unruptured and ruptured aneurysms. The lifetime lesion rupture probability for individual patients with various ages and aneurysm sizes was also computed, thereby providing a useful index to help patients in the medical decision-making process. The computer model produced a sample of unruptured aneurysms in the general population with a prevalence of 4.2% and a median diameter of 5.8 mm. These unruptured aneurysms—affected by the rupture rate reported in the ISUIA—had a yearly SAH incidence of 19.6 per 100,000 persons. The median diameter of these aneurysms was 9.4 mm. Conclusions Findings in the present study validated the results of the ISUIA by showing that the seemingly low rupture rates could explain the statistical data for ruptured aneurysms. With the featured model, the author calculated the lifetime probability of lesion rupture—a useful measure for deciding on the optimal treatment for unruptured aneurysms.

scholarly journals Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

2020 ◽  
Vol 9 (9) ◽  
pp. 2808
Author(s):  
Wojciech Poncyljusz ◽  
Kinga Kubiak ◽  
Leszek Sagan ◽  
Bartosz Limanówka ◽  
Katarzyna Kołaczyk
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Clinical Results ◽  
Class I ◽  
Unruptured Aneurysms ◽  
Patient Demographics ◽  
Stent Deformation ◽  
Unruptured Intracranial Aneurysms ◽  
Occlusion Rate

Background: Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. Materials and Methods: It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. Results: Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. Conclusion: The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms.

scholarly journals Peri-Procedural Morbidity and Mortality Associated with Stent-Assisted Coiling for Intracranial Aneurysms

2013 ◽  
Vol 19 (1) ◽  
pp. 43-48 ◽  
Author(s):  
K. Wang ◽  
Y. Sun ◽  
A-M. Li
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Mortality Rates ◽  
Stent Migration ◽  
Aneurysm Rupture ◽  
Morbidity And Mortality ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Attractive Option ◽  
Technological Improvements

Despite experience and technological improvements, stent-assisted coiling for intracranial aneurysms still has inherent risks. We evaluated peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms. Patients with cerebral aneurysms that were broad-based (>4 mm) or had unfavorable dome/neck ratios (<1.5) were enrolled in this study between February and November 2011 at our center. Aneurysms were treated with the self-expanding neurovascular stents with adjunctive coil embolization. Seventy-two consecutive patients (27 men and 45 women; 22–78 years of age; mean age, 52.8 years) underwent 13 procedures for 13 ruptured aneurysms and 64 procedures for 73 unruptured aneurysms. Nine [11.7%, 95% CI(4.5%–18.9%)] procedure-related complications occurred: one and eight with initial embolization of ruptured and unruptured aneurysms, respectively. Complications included six acute in-stent thromboses, one spontaneous stent migration, one post-procedural aneurysm rupture, and one perforator occlusion. Three complications had no neurologic consequences. Two caused transient neurologic morbidity, two persistent neurologic morbidity, and two death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 5.2% (95%CI, 0.2%–10.2%) and 2.6% (95%CI, 0%–6.2%); ruptured aneurysms, 7.7% (95%CI, 0%–36%) and 0% (95%CI, 0%–25%); unruptured aneurysms, 4.7% (95%CI, 0%–9.9%) and 3.1% (95%CI, 0%–7.3%). Combined procedure-related morbidity and mortality rates for ruptured and unruptured aneurysms were 7.7% (95%CI, 1.7%–13.7%) and 7.8% (95%CI, 1.8%–13.8%), respectively. Stent-assisted coiling is an attractive option for intracranial aneurysms. However, stent-assisted coiling for unruptured aneurysms is controversial for its comparable risk to natural history.

scholarly journals Long-Term Follow-up Study of Endovascularly Treated Intracranial Aneurysms

2010 ◽  
Vol 16 (3) ◽  
pp. 231-239 ◽  
Author(s):  
L.M. Pyysalo ◽  
L.H. Keski-Nisula ◽  
T.T. Niskakangas ◽  
V.J. Kähärä ◽  
J.E. Öhman
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Bleeding Rate ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
Rebleeding Rate

Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess the long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms. The clinical outcome of all 185 patients with endovascularly treated aneurysms were analyzed and 77 out of 122 surviving patients were examined with MRI and MRA nine to 16 years (mean 11 years) after the initial endovascular treatment. Sixty-three patients were deceased at the time of follow-up. The cause of death was aneurysm-related in 34 (54%) patients. The annual rebleeding rate from the treated aneurysms was 1.3% in the ruptured group and 0.1% in the unruptured group. In long-term follow-up MRA 18 aneurysms (53%) were graded as complete, 11 aneurysms (32%) had neck remnants and five aneurysms (15%) were incompletely occluded in the ruptured group. The occlusion grade was lower in the unruptured group with 20 aneurysms (41%) graded as complete, 11 (22%) had neck remnants and 18 (37%) were incomplete. However, only three aneurysms were unstable during the follow-up period and needed retreatment. Endovascular treatment of unruptured aneurysms showed incomplete angiographic outcome in 37% of cases. However, the annual bleeding rate was as low as 0.1%. Endovascular treatment of ruptured aneurysms showed incomplete angiographic outcome in 15% of cases and the annual rebleeding rate was 1,3%.

Intraoperative motor and somatosensory evoked potential monitoring during surgical clipping of ruptured and unruptured intracranial aneurysms: a comparative study

2021 ◽  
pp. 1-8
Author(s):  
Hao You ◽  
Xing Fan ◽  
Jiajia Liu ◽  
Dongze Guo ◽  
Zhibao Li ◽  
...  
Keyword(s):  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Critical Values ◽  
Somatosensory Evoked Potential ◽  
Short Term ◽  
Surgical Clipping ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms

OBJECTIVE The current study investigated the correlation between intraoperative motor evoked potential (MEP) and somatosensory evoked potential (SSEP) monitoring and both short-term and long-term motor outcomes in aneurysm patients treated with surgical clipping. Moreover, the authors provide a relatively optimal neurophysiological predictor of postoperative motor deficits (PMDs) in patients with ruptured and unruptured aneurysms. METHODS A total of 1017 patients (216 with ruptured aneurysms and 801 with unruptured aneurysms) were included. Patient demographic characteristics, clinical features, intraoperative monitoring data, and follow-up data were retrospectively reviewed. The efficacy of using changes in MEP/SSEP to predict PMDs was assessed using binary logistic regression analysis. Subsequently, receiver operating characteristic curve analysis was performed to determine the optimal critical value for duration of MEP/SSEP deterioration. RESULTS Both intraoperative MEP and SSEP monitoring were significantly effective for predicting short-term (p < 0.001 for both) and long-term (p < 0.001 for both) PMDs in aneurysm patients. The critical values for predicting short-term PMDs were amplitude decrease rates of 57.30% for MEP (p < 0.001 and area under the curve [AUC] 0.732) and 64.10% for SSEP (p < 0.001 and AUC 0.653). In patients with an unruptured aneurysm, the optimal critical values for predicting short-term PMDs were durations of deterioration of 17 minutes for MEP (p < 0.001 and AUC 0.768) and 21 minutes for SSEP (p < 0.001 and AUC 0.843). In patients with a ruptured aneurysm, the optimal critical values for predicting short-term PMDs were durations of deterioration of 12.5 minutes for MEP (p = 0.028 and AUC 0.706) and 11 minutes for SSEP (p = 0.043 and AUC 0.813). CONCLUSIONS The authors found that both intraoperative MEP and SSEP monitoring are useful for predicting short-term and long-term PMDs in patients with unruptured and ruptured aneurysms. The optimal intraoperative neuromonitoring method for predicting PMDs varies depending on whether the aneurysm has ruptured or not.

scholarly journals Subarachnoid hemorrhage after surgical treatment of unruptured intracranial aneurysms

2018 ◽  
Vol 129 (2) ◽  
pp. 490-497
Author(s):  
Hidetoshi Matsukawa ◽  
Hiroyasu Kamiyama ◽  
Toshiyuki Tsuboi ◽  
Kosumo Noda ◽  
Nakao Ota ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Incidence Rate ◽  
Intracranial Aneurysms ◽  
Annual Incidence ◽  
Annual Incidence Rate ◽  
Excellent Outcome ◽  
Unruptured Intracranial Aneurysms ◽  
Average Annual Incidence

OBJECTIVEOnly a few previous studies have investigated subarachnoid hemorrhage (SAH) after surgical treatment in patients with unruptured intracranial aneurysms (UIAs). Given the improvement in long-term outcomes of embolization, more extensive data are needed concerning the true rupture rates after microsurgery in order to provide reliable information for treatment decisions. The purpose of this study was to investigate the incidence of and risk factors for postoperative SAH in patients with surgically treated UIAs.METHODSData from 702 consecutive patients harboring 852 surgically treated UIAs were evaluated. Surgical treatments included neck clipping (complete or incomplete), coating/wrapping, trapping, proximal occlusion, and bypass surgery. Clippable UIAs were defined as UIAs treated by complete neck clipping. The annual incidence of postoperative SAH and risk factors for SAH were studied using Kaplan-Meier survival analysis and Cox proportional hazards regression models.RESULTSThe patients’ median age was 64 years (interquartile range [IQR] 56–71 years). Of 852 UIAs, 767 were clippable and 85 were not. The mean duration of follow-up was 731 days (SD 380 days). During 1708 aneurysm years, there were 4 episodes of SAH, giving an overall average annual incidence rate of 0.23% (95% CI 0.12%–0.59%) and an average annual incidence rate of 0.065% (95% CI 0.0017%–0.37%) for clippable UIAs (1 episode of SAH, 1552 aneurysm-years). Basilar artery location (adjusted hazard ratio [HR] 23, 95% CI 2.0–255, p = 0.0012) and unclippable UIA status (adjusted HR 15, 95% CI 1.1–215, p = 0.046) were significantly related to postoperative SAH. An excellent outcome (modified Rankin Scale score of 0 or 1) was achieved in 816 (95.7%) of 852 cases overall and in 748 (98%) of 767 clippable UIAs at 12 months.CONCLUSIONSIn this large case series, microsurgical treatment of UIAs was found to be safe and effective. Aneurysm location and unclippable morphologies were related to postoperative SAH in patients with surgically treated UIAs.

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