G Durner1, M Piano2, P Lenga3, D Mielke4, C Hohaus5, S Guhl6, N Maldaner7, J K Burkhardt7, M T Pedro1, J Lehmberg8, D Rufenacht9, P Bijlenga10, N Etminan11, J K Krauss12, E Boccardi2, D Hänggi11, P Vajkoczy3, Julius Dengler13. 1. Department of Neurosurgery, Bezirkskrankenhaus Günzburg, University of Ulm, Günzburg, Germany. 2. Department of Neuroradiology, Metropolitan Hospital Niguarda, Milan, Italy. 3. Department of Neurosurgery, Charité-Universitaetsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany. 4. Department of Neurosurgery, Georg-August-University Goettingen, Goettingen, Germany. 5. Department of Neurosurgery, BG-Clinic Bergmannstrost, Halle, Germany. 6. Department of Neurosurgery, University of Greifswald, Greifswald, Germany. 7. Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland. 8. Department of Neurosurgery, Technical University of Munich, Munich, Germany. 9. Department of Neuroradiology, Clinic Hirslanden, Zurich, Switzerland. 10. Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland. 11. Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany. 12. Department of Neurosurgery, Hannover Medical School, Hannover, Germany. 13. Department of Neurosurgery, Charité-Universitaetsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany. julius.dengler@charite.de.
Abstract
BACKGROUND: Giant cavernous carotid aneurysms (GCCAs) usually exert substantial mass effect on adjacent intracavernous cranial nerves. Since predictors of cranial nerve deficits (CNDs) in patients with GCCA are unknown, we designed a study to identify associations between CND and GCCA morphology and the location of mass effect. METHODS: This study was based on data from the prospective clinical and imaging databases of the Giant Intracranial Aneurysm Registry. We used magnetic resonance imaging and digital subtraction angiography to examine GCCA volume, presence of partial thrombosis (PT), GCCA origins, and the location of mass effect. We also documented whether CND was present. RESULTS: We included 36 GCCA in 34 patients, which had been entered into the registry by eight participating centers between January 2009 and March 2016. The prevalence of CND was 69.4%, with one CND in 41.7% and more than one in 27.5%. The prevalence of PT was 33.3%. The aneurysm origin was most frequently located at the anterior genu (52.8%). The prevalence of CND did not differ between aneurysm origins (p = 0.29). Intracavernous mass effect was lateral in 58.3%, mixed medial/lateral in 27.8%, and purely medial in 13.9%. CND occurred significantly more often in GCCA with lateral (81.0%) or mixed medial/lateral (70.0%) mass effect than in GCCA with medial mass effect (20.0%; p = 0.03). After adjusting our data for the effects of the location of mass effect, we found no association between the prevalence of CND and aneurysm volume (odds ratio (OR) 1.30 (0.98-1.71); p = 0.07), the occurrence of PT (OR 0.64 (0.07-5.73); p = 0.69), or patient age (OR 1.02 (95% CI 0.95-1.09); p = 0.59). CONCLUSIONS: Distinguishing between medial versus lateral location of mass effect may be more helpful than measuring aneurysm volumes or examining aneurysm thrombosis in understanding why some patients with GCCA present with CND while others do not. CLINICAL TRIAL REGISTRATION NO: NCT02066493 ( clinicaltrials.gov ).
BACKGROUND: Giant cavernous carotid aneurysms (GCCAs) usually exert substantial mass effect on adjacent intracavernous cranial nerves. Since predictors of cranial nerve deficits (CNDs) in patients with GCCA are unknown, we designed a study to identify associations between CND and GCCA morphology and the location of mass effect. METHODS: This study was based on data from the prospective clinical and imaging databases of the Giant Intracranial Aneurysm Registry. We used magnetic resonance imaging and digital subtraction angiography to examine GCCA volume, presence of partial thrombosis (PT), GCCA origins, and the location of mass effect. We also documented whether CND was present. RESULTS: We included 36 GCCA in 34 patients, which had been entered into the registry by eight participating centers between January 2009 and March 2016. The prevalence of CND was 69.4%, with one CND in 41.7% and more than one in 27.5%. The prevalence of PT was 33.3%. The aneurysm origin was most frequently located at the anterior genu (52.8%). The prevalence of CND did not differ between aneurysm origins (p = 0.29). Intracavernous mass effect was lateral in 58.3%, mixed medial/lateral in 27.8%, and purely medial in 13.9%. CND occurred significantly more often in GCCA with lateral (81.0%) or mixed medial/lateral (70.0%) mass effect than in GCCA with medial mass effect (20.0%; p = 0.03). After adjusting our data for the effects of the location of mass effect, we found no association between the prevalence of CND and aneurysm volume (odds ratio (OR) 1.30 (0.98-1.71); p = 0.07), the occurrence of PT (OR 0.64 (0.07-5.73); p = 0.69), or patient age (OR 1.02 (95% CI 0.95-1.09); p = 0.59). CONCLUSIONS: Distinguishing between medial versus lateral location of mass effect may be more helpful than measuring aneurysm volumes or examining aneurysm thrombosis in understanding why some patients with GCCA present with CND while others do not. CLINICAL TRIAL REGISTRATION NO: NCT02066493 ( clinicaltrials.gov ).
Authors: Michael Karl Fehrenbach; Eric Dietel; Tim Wende; Johannes Kasper; Caroline Sander; Florian Wilhelmy; Ulf Quaeschling; Juergen Meixensberger; Ulf Nestler Journal: Brain Sci Date: 2022-02-28