Clinical characteristics and surgical treatment of patients with giant intracranial aneurysms

Abstract BACKGROUND: Giant intracranial aneurysms (GIAs), which are defined as intracranial aneurysms (IAs) with a diameter of ≥25 mm, are most likely associated with the highest treatment costs of all IAs. However, the treatment costs of unruptured GIAs have so far not been reported. OBJECTIVE: To examine direct costs of endovascular and surgical treatment of unruptured GIAs. METHODS: We retrospectively examined 55 patients with unruptured GIAs treated surgically (37 patients) or endovascularly (18 patients) between April 2004 and March 2014. We analyzed the costs of all hospital stays, interventions, and imaging with a median follow-up of 46 months. RESULTS: There was no difference in the costs of hospital stay between surgical and endovascular treatment groups ($10 565 vs $14 992; P = .37). Imaging costs were significantly higher in the surgical group than in the endovascular treatment group ($2890 vs $1612; P < .01), as were the costs of the intervention room and personnel involved in the intervention ($5566 vs $1520; P < .01). Implants used per patient were more expensive in the endovascular group than in the surgical treatment group ($20 885 vs $167). The total direct treatment costs were higher in the endovascular group ($52 325) than in the surgical treatment group ($20 619; P < .01). Treatment costs were associated with the type of treatment and GIA location but not with patient age, sex, or GIA size. CONCLUSION: Endovascular GIA treatment produced higher direct costs than surgical GIA treatment mainly due to higher implant costs. Reducing endovascular implant costs may be the most effective tool to decrease direct costs of GIA treatment.

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Pediatric intracranial aneurysms—clinical characteristics and outcome of surgical treatment

Child s Nervous System ◽

10.1007/s00381-006-0253-x ◽

2006 ◽

Vol 23 (3) ◽

pp. 327-333 ◽

Cited By ~ 41

Author(s):

B. S. Sharma ◽

Sumit Sinha ◽

V. S. Mehta ◽

A. Suri ◽

Aditya Gupta ◽

...

Keyword(s):

Surgical Treatment ◽

Intracranial Aneurysms ◽

Clinical Characteristics

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Direct Surgical Treatment of Giant Intracranial Aneurysms

Neurological Research ◽

10.1080/01616412.1980.11739585 ◽

1980 ◽

Vol 2 (1) ◽

pp. 305-325 ◽

Cited By ~ 8

Author(s):

Jiro Suzuki ◽

Tomohiko Sato

Keyword(s):

Surgical Treatment ◽

Intracranial Aneurysms ◽

Giant Intracranial Aneurysms

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Outcome of Surgical or Endovascular Treatment of Giant Intracranial Aneurysms, with Emphasis on Age, Aneurysm Location, and Unruptured Aneuryms - A Systematic Review and Meta-Analysis

Cerebrovascular Diseases ◽

10.1159/000443485 ◽

2016 ◽

Vol 41 (3-4) ◽

pp. 187-198 ◽

Cited By ~ 17

Author(s):

Julius Dengler ◽

Nicolai Maldaner ◽

Sven Gläsker ◽

Matthias Endres ◽

Martin Wagner ◽

...

Keyword(s):

Treatment Outcome ◽

Surgical Treatment ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Meta Analysis ◽

Separate Analysis ◽

Patient Age ◽

Good Outcome ◽

Giant Intracranial Aneurysms ◽

Patient Âgé

Background: Designing treatment strategies for unruptured giant intracranial aneurysms (GIA) is difficult as evidence of large clinical trials is lacking. We examined the outcome following surgical or endovascular GIA treatment focusing on patient age, GIA location and unruptured GIA. Methods: Medline and Embase were searched for studies reporting on GIA treatment outcome published after January 2000. We calculated the proportion of good outcome (PGO) for all included GIA and for unruptured GIA by meta-analysis using a random effects model. Results: We included 54 studies containing 64 study populations with 1,269 GIA at a median follow-up time (FU-T) of 26.4 months (95% CI 10.8-42.0). PGO was 80.9% (77.4-84.4) in the analysis of all GIA compared to 81.2% (75.3-86.1) in the separate analysis of unruptured GIA. For each year added to patient age, PGO decreased by 0.8%, both for all GIA and unruptured GIA. For all GIA, surgical treatment resulted in a PGO of 80.3% (95% CI 76.0-84.6) compared to 84.2% (78.5-89.8, p = 0.27) after endovascular treatment. In unruptured GIA, PGO was 79.7% (95% CI 71.5-87.8) after surgical treatment and 84.9% (79.1-90.7, p = 0.54) after endovascular treatment. PGO was lower in high quality studies and in studies presenting aggregate instead of individual patient data. In unruptured GIA, the OR for good treatment outcome was 5.2 (95% CI 2.0-13.0) at the internal carotid artery compared to 0.1 (0.1-0.3, p < 0.1) in the posterior circulation. Patient sex, FU-T and prevalence of ruptured GIA were not associated with PGO. Conclusions: We found that the chances of good outcome after surgical or endovascular GIA treatment mainly depend on patient age and aneurysm location rather than on the type of treatment conducted. Our analysis may inform future research on GIA.

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