Anne-Laure Bernat1, Frédéric Clarençon2, Arthur André3, Aurélien Nouet4, Stéphane Clémenceau4, Nader-Antoine Sourour5, Federico Di Maria5, Vincent Degos6, Jean-Louis Golmard7, Philippe Cornu8, Anne-Laure Boch4. 1. Department of Neurosurgery, Lariboisière University Hospital, AP-HP, 75010 Paris, France; Paris VII University, Paris Diderot, Paris, France. Electronic address: annelaure.bernat@aphp.fr. 2. Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France; Paris VI University, Pierre-et-Marie-Curie, Paris, France. 3. Department of Neurosurgery, Lariboisière University Hospital, AP-HP, 75010 Paris, France; Paris VI University, Pierre-et-Marie-Curie, Paris, France. 4. Department of Neurosurgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France. 5. Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France. 6. Paris VI University, Pierre-et-Marie-Curie, Paris, France; Department of Anesthesia and Perioperative Care, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France. 7. Paris VI University, Pierre-et-Marie-Curie, Paris, France; Department of Biomedical Statistics, Pitié-Salpêtrière University Hospital, AP-HP, 75013 Paris, France. 8. Department of Neurosurgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France; Paris VI University, Pierre-et-Marie-Curie, Paris, France.
Abstract
BACKGROUND: Long-term stability after intracranial aneurysm exclusion by coiling is still a matter of debate; after surgical clipping little is known. OBJECTIVE: To study outcome after endovascular and surgical treatments for unruptured intracranial aneurysms in terms of short- and long-term angiographic exclusion and risk factors for recanalization. METHODS: From 2004 and 2009, patients treated for unruptured berry intracranial aneurysms by coiling or clipping were reviewed. Aneurysmal exclusion was evaluated using the Roy-Raymond grading scale; immediate clinical outcome was also assessed. Clinical outcome, recanalization, risk factors for recurrence and bleeding during the follow-up period were analyzed by groups; "surgery" and "embolization". RESULTS: From 2004 to 2009, 178 consecutive unruptured aneurysms were treated. The post-procedure angiographic results for "surgery" were: total exclusion 75.6%; residual neck 13.5%; residual aneurysm 10.8%. For "embolization", the results were, respectively: 72%; 20.7%; and 7.2%. Morbidity was 3% for "surgery" and 1.6% for "embolization" (P=0.74); mortality was nil. Mean clinical and angiographic follow-up was 5years. Recurrence rate was of 11.5% for "surgery" vs. 44% for "embolization" with a mean follow-up of 4 and 5.75years, respectively (P=1.10-5). The retreatment rate was 8.4%. Two significant risk factors for recanalization were identified: maximum diameter of the aneurysm sac (P=0.0038) and pericallosal location (P=0.0388). No bleeding event occurred. CONCLUSION: Both techniques are safe. The rate of aneurismal recurrence was significantly higher for embolization, especially for large diameter aneurysms and pericallosal locations. No bleeding event occurred after recanalization.
BACKGROUND: Long-term stability after intracranial aneurysm exclusion by coiling is still a matter of debate; after surgical clipping little is known. OBJECTIVE: To study outcome after endovascular and surgical treatments for unruptured intracranial aneurysms in terms of short- and long-term angiographic exclusion and risk factors for recanalization. METHODS: From 2004 and 2009, patients treated for unruptured berry intracranial aneurysms by coiling or clipping were reviewed. Aneurysmal exclusion was evaluated using the Roy-Raymond grading scale; immediate clinical outcome was also assessed. Clinical outcome, recanalization, risk factors for recurrence and bleeding during the follow-up period were analyzed by groups; "surgery" and "embolization". RESULTS: From 2004 to 2009, 178 consecutive unruptured aneurysms were treated. The post-procedure angiographic results for "surgery" were: total exclusion 75.6%; residual neck 13.5%; residual aneurysm 10.8%. For "embolization", the results were, respectively: 72%; 20.7%; and 7.2%. Morbidity was 3% for "surgery" and 1.6% for "embolization" (P=0.74); mortality was nil. Mean clinical and angiographic follow-up was 5years. Recurrence rate was of 11.5% for "surgery" vs. 44% for "embolization" with a mean follow-up of 4 and 5.75years, respectively (P=1.10-5). The retreatment rate was 8.4%. Two significant risk factors for recanalization were identified: maximum diameter of the aneurysm sac (P=0.0038) and pericallosal location (P=0.0388). No bleeding event occurred. CONCLUSION: Both techniques are safe. The rate of aneurismal recurrence was significantly higher for embolization, especially for large diameter aneurysms and pericallosal locations. No bleeding event occurred after recanalization.
Authors: Cathal John Hannan; Abdurrahman I Islim; Andrew F Alalade; Andrew Bacon; Anthony Ghosh; Arthur Dalton; Ashraf Abouharb; Daniel Colman Walsh; Diederik Bulters; Edward White; Emmanouil Chavredakis; George Kounin; Giles Critchley; Graham Dow; Hiren C Patel; Howard Brydon; Ian A Anderson; Ioannis Fouyas; James Galea; Jerome St George; Jarnail Bal; Krunal Patel; Mahmoud Kamel; Mario Teo; Noel Fanning; Nitin Mukerji; Patrick Grover; Patrick Mitchell; Peter C Whitfield; Rikin Trivedi; Matthew T Crockett; Paul Brennan; Mohsen Javadpour Journal: Acta Neurochir (Wien) Date: 2022-10-11 Impact factor: 2.816