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  • CLIP LIGATION OF UNRUPTURED INTRACRANIAL ANEURYSMS: A PROSPECTIVE MIDTERM OUTCOME STUDY

    Final Number:
    314

    Authors:
    Yunus Aydin; Halit Çavusoglu MD; Okan Kahyaoglu; Ahmet Müslüman; Osman Türkmenoglu; Adem Yilmaz; Meltem Can; Yüksel Sahin

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: We have conducted a prospective study to investigate the clinical and radiological outcome in surgical case series of 176 patients with 203 unruptured intracranial aneurysms (UIA).

    Methods: Success of aneurysm obliteration was assessed within two weeks after surgery by digital subtraction angiography (DSA). Patients also underwent angiography five years after surgery. Clinical outcomes were assessed using the modified Rankin Scale (mRS). All predictors of poor surgical outcomes were assessed using an exact logistic regression.

    Results: Overall, 83% of the patients had a good outcome (mRS Score 0 or 1). 10.8% of the patients had a slight disability (mRS Score 2) and 6,2% of the patients had a moderate or moderate severe disability (mRS Score 3 or 4). The most important predictors of outcome were presence of history of ischemic cerebrovascular disease and postoperative stroke. Complete aneurysm occlusion was achieved in 93,5% of all anuerysyms. 60% of treated aneurysms were checked with late follow-up DSA. No cases of hemorrhage from a surgically obliterated UIA have been documented in this series during follow up period of 8.1 ± SD 1.2 years.

    Conclusions: If patients are carefully selected and individually assigned to their optimum treatment modality, IUAs can be oblitared by surgery with a low percentage of unfavorable outcomes.

    Patient Care: We believe that UIAs of any size are potentially dangerous lesions. Surgical clipping, with acceptable risks and good occlusion rates, is the treatment of choice in patients with UIA.Meeting of small aneurysms which can not showed with DSA is the another advantages of surgery.

    Learning Objectives: Multivariate analysis identified four preoperative predictors of a poor outcome following clip ligation of UIAs; 1)the presence of history of ischemic cerebrovascular disease, 2)the presence of preoperative disability, 3)an age of older than 60 year, 4)an aneurysm size > 2,5 cm. No intraoperative factor reached significance in the multivariate analysis. Multivariate analysis identified one postoperative predictors of a poor outcome; the occurrence of ischemic stroke postoperatively was highly predictive of a poor outcome.

    References:

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