Unruptured intracranial aneurysms: seizures and antiepileptic drug treatment following surgery

1991 ◽  
Vol 75 (3) ◽  
pp. 371-373 ◽  
Author(s):  
Adrian L. Rabinowicz ◽  
David L. Ginsburg ◽  
Christopher M. DeGiorgio ◽  
Peggy S. Gott ◽  
Steven L. Giannotta
Keyword(s):  
Drug Treatment ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Intracranial Aneurysms ◽  
Content Type ◽  
Unruptured Intracranial Aneurysms ◽  
Antiepileptic Drug Treatment ◽  
Fine Print ◽  
Overall Risk

✓ Twenty-one patients operated on for unruptured intracranial aneurysms were studied retrospectively in order to identify the incidence of postoperative seizures, factors predictive of seizures, and the response to discontinuation of antiepileptic drugs. The overall risk of postoperative seizures in initially seizure-free patients was 15.7%. Although seizures were not uncommon, antiepileptic drugs were successfully tapered in most of the patients before 12 months.

Surgical management of unruptured intracranial aneurysms

1994 ◽  
Vol 80 (3) ◽  
pp. 440-446 ◽  
Author(s):  
Robert A. Solomon ◽  
Matthew E. Fink ◽  
John Pile-Spellman
Keyword(s):  
Surgical Management ◽  
Intracranial Aneurysms ◽  
Clinical Decision Making ◽  
Mass Effect ◽  
Endovascular Embolization ◽  
Surgical Morbidity ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Fine Print

✓ The surgical management of patients with unruptured intracranial aneurysms continues to be controversial. The criteria for withholding treatment or choosing between endovascular embolization and conventional microsurgery are not well delineated. The present study analyzes the morbidity and mortality that can be expected with modern surgical management of unruptured aneurysms, and therefore serves as a point of reference for clinical decision-making in this group of patients. A total of 202 consecutive operations for attempted clipping of unruptured intracranial aneurysms are reported. Subarachnoid hemorrhage from another aneurysm was the most common presentation (55 cases). Thirty-seven patients presented with headache, 36 with mass effect from the aneurysm, and 19 with embolic events; 11 aneurysms were associated with an arteriovenous malformation, 10 caused seizures, and 34 were incidental findings. Excellent or good outcome was achieved in 100% of patients with aneurysms less than 10 mm in diameter, 95% with aneurysms 11 to 25 mm, and 79% with aneurysms greater than 25 mm. Except for giant basilar aneurysms, size (and not location) of the aneurysm was the key predictor of risk for surgical morbidity. These data may be useful when discussing with patients the risk:benefit ratio of choosing between conservative management, endovascular embolization, and microsurgical clipping.

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.

Predicting outcome following surgical treatment of unruptured intracranial aneurysms: a proposed grading system

1996 ◽  
Vol 84 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Rohit K. Khanna ◽  
Ghaus M. Malik ◽  
Nuzhat Qureshi
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Poor Outcome ◽  
Unruptured Intracranial Aneurysms ◽  
Predicting Outcome ◽  
Fine Print

✓ Surgical treatment of unruptured aneurysms is gaining increased support owing to the recently defined poor long-term natural history of these aneurysms. The benefit of treatment ultimately depends on the relative risk of subsequent aneurysm rupture in untreated patients versus the risk of surgery. To identify those patients at a higher risk from surgery, the authors reviewed the management of 172 patients with unruptured intracranial aneurysms treated at their institution. The size of the aneurysms ranged from 3 to 45 mm (mean 13.7 mm). Twenty-two patients (12.8%) had aneurysms in the posterior circulation, and 32 (18.6%) of these were giant aneurysms. Major morbidity occurred in 12 patients (6.9%) and five patients (2.9%) died. Multivariate logistic analysis of several risk factors revealed that aneurysm size and location had an independent correlation with surgical outcome and that patient age approached statistical significance. Patients presenting with ischemic cerebrovascular disease, in particular, did not have a higher risk of a poor outcome. A simple classification for predicting patients at high risk from surgical morbidity and mortality is proposed. Preoperative grading is based on the size and location of the aneurysm and patient's age. The lowest grade is given to young patients with small anterior circulation aneurysms, and the highest grade includes elderly patients with complex giant posterior circulation aneurysms. A retrospective analysis of this classification demonstrated a strong correlation with postoperative outcome. The incidence of poor outcome progressively increased with a higher grade, ranging from 0% in Grade 0 to 66.6% in Grade VI. An analysis of this classification on 50 consecutive surgically treated patients with unruptured aneurysms not included in the analysis also validated the predictive value of this system. Along with predicting outcome, this classification should provide a standardized format for comparison of results from different clinical centers as well as different therapeutic techniques (surgical vs. endovascular) without omission of significant risk factors found to influence outcome.

Elective surgery for asymptomatic, unruptured, intracranial aneurysms: a cost-effectiveness analysis

1995 ◽  
Vol 83 (3) ◽  
pp. 403-412 ◽  
Author(s):  
Joseph T. King ◽  
Henry A. Glick ◽  
Thomas J. Mason ◽  
Eugene S. Flamm
Keyword(s):  
Cost Effectiveness ◽  
Intracranial Aneurysms ◽  
Elective Surgery ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Aneurysm Surgery ◽  
Content Type ◽  
Effectiveness Analysis ◽  
Unruptured Intracranial Aneurysms ◽  
Fine Print

✓ Cost-effectiveness analysis uses both economic and clinical outcomes data to evaluate treatment options. In this era of economic constraints on health care, treatments that are not cost-effective will increasingly be denied public and private insurance reimbursement. The authors used mathematical modeling techniques to assess the cost-effectiveness of elective surgery for the treatment of asymptomatic, unruptured, intracranial aneurysms. Input values for the Markov model used in this study were determined from both the literature and clinical judgment. Direct medical costs for hospitalization and physician fees were derived from Medicare cost reports and resource-based relative-value units, expressed in 1992 U.S. dollars. Costs and benefits were discounted at an annual rate of 5%. Using baseline model assumptions for a 50-year-old patient, elective aneurysm surgery provides an average of 0.88 additional quality-adjusted life years (QALYs) compared with nonsurgical treatment. However, prompt elective surgery ($23,300) costs more than expectant management ($2100), in which only patients whose aneurysms rupture incur treatment costs. Combining the outcomes and cost data, the incremental cost-effectiveness of elective aneurysm surgery is $24,200 per QALY, which is comparable to other accepted medical or surgical interventions, such as total knee arthroplasty ($15,200/QALY) or antihypertensive therapy in a 50-year-old patient ($29,800/QALY). Prompt elective surgery for asymptomatic, unruptured, intracranial aneurysms is recommended as a cost-effective use of medical resources provided: 1) surgical morbidity and mortality remain at reported levels; 2) the patient has a life expectancy of at least 13 additional years; and 3) the patient experiences a decrease in quality of life from knowingly living with an unruptured aneurysm.

Functional outcome after repair of unruptured intracranial aneurysms

2001 ◽  
Vol 94 (3) ◽  
pp. 417-421 ◽  
Author(s):  
Douglas Chyatte ◽  
Rebecca Porterfield
Keyword(s):  
Functional Outcome ◽  
Intracranial Aneurysms ◽  
Patient Age ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Aneurysm Size ◽  
Patient Âgé ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference ◽  
Fine Print

Object. Repair of unruptured aneurysms is a reasonable course of action if their expected natural history is worse than the predicted risks of treatment. The purpose of this study was to examine the presenting symptoms of unruptured aneurysms and to test the hypothesis that unruptured intracranial aneurysms can be repaired without significant functional worsening. A second hypothesis was also examined—that is, that the experience of the surgeon, the aneurysm size, and the patient age can be used to predict functional outcome. Methods. Consecutive patients who underwent repair of an unruptured intracranial aneurysm at a single institution between 1980 and 1998 were studied. Clinical and radiographic data were collected in all patients. Their modified Rankin Scale (mRS) score was determined before treatment (baseline), at 6 weeks, and at 6 months. The primary endpoint for analysis was the mRS score. Four hundred forty-nine aneurysms were repaired in 366 patients by 10 surgeons. The mean size of the primary lesion repaired was 14.6 + 10.4 mm and 27% were judged to be symptomatic. Aneurysm treatment involved either microsurgical clipping (78%), wrapping (4%), trapping with or without bypass (5%), hunterian ligation with or without bypass (9%), or other methods (4%). The mRS scores at 6 weeks were worse than at baseline (p < 0.0001), but there was no significant difference between the baseline and 6-month mRS score. At 6 months, 94% of patients showed no significant functional worsening as a result of treatment. The number of aneurysms treated by a specific surgeon was a strong predictor of better functional outcome (r = 0.99, p = 0.05). Increasing patient age (r = 0.16, p = 0.003) and increasing aneurysm size (r = 0.15, p = 0.004) were predictors of worsened functional outcome. Conclusions. Many unruptured aneurysms produce symptoms. Unruptured intracranial aneurysms can be treated without significant permanent functional worsening. The surgeon's experience, aneurysm size, and patient age are predictors of functional outcome.

Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: a meta-analysis

1994 ◽  
Vol 81 (6) ◽  
pp. 837-842 ◽  
Author(s):  
Joseph T. King ◽  
Jesse A. Berlin ◽  
Eugene S. Flamm
Keyword(s):  
Confidence Interval ◽  
Intracranial Aneurysms ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Content Type ◽  
Unruptured Intracranial Aneurysms ◽  
The Impact ◽  
Fine Print

✓ A meta-analysis of the literature on morbidity and mortality from elective surgery for asymptomatic unruptured intracranial aneurysms was performed to obtain a more precise, accurate, and generalizable estimate of operative risk than is currently available. The authors used a MEDLINE search from 1966 to 1992, supplemented with manual searches, to locate studies containing four or more patients who had undergone elective surgery for these aneurysms. Only patients with asymptomatic, unruptured aneurysms were eligible for inclusion. Demographic and clinical data were collected from each series; aneurysms were categorized as incidental, multiple, or unclassifiable. Data were analyzed using Fisher's exact test and logistical regression. There were twenty-eight articles containing data on 733 patients who met eligibility criteria. The mean patient age was 48.6 ± 5.5 years, and 55% ± 17% of the patients were women. There was a total of 30 deficits for a morbidity rate of 4.1% (95% confidence interval 2.8, 5.8%) and a total of seven deaths for a mortality rate of 1.0% (95% confidence interval 0.4, 2.0%). There was insufficient statistical power to detect a difference in morbidity or mortality rates related to study size, year of publication, or potential risk factors such as patient sex or age, or aneurysm size, location, or category (incidental, multiple, or unclassifiable) (for all analyses, p ≥ 0.16). Elective surgery for asymptomatic unruptured intracranial aneurysms, as reported in the literature, has low rates of morbidity (4.1%) and mortality (1.0%). At present there is insufficient detail in the literature to understand the impact of patient and aneurysm characteristics on elective surgical outcomes.

Sign in / Sign up

Export Citation Format

Share Document