Antonius M de Korte1, René Aquarius2, Frederick J A Meijer3, Hieronymus D Boogaarts4, Joost de Vries4. 1. Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: thomas.dekorte@radboudumc.nl. 2. Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands. 3. Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands. 4. Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Abstract
OBJECTIVE: Patients with large and giant intracranial aneurysms (IAs) can experience neurological deterioration within 6 months after successful flow diverter (FD) placement. The purpose of the present study was to assess whether the occurrence of neurological deterioration can be linked to IA expansion within 6 months after FD treatment. METHODS: From 2010 to 2016, 45 FD procedures were performed in 44 patients with a large or giant IA. From this group, we selected all patients (14 patients with 15 IAs) with neurological deterioration within 6 months after FD treatment. All these patients had undergone follow-up imaging studies within the same period. The patients were then divided into 2 groups, those with mass effect-related and those with ischemia-related symptoms. The volumes of all treated IAs were determined through manual segmentation of the available pre- and postoperative imaging studies to determine IA expansion after FD treatment. To rule out false-positive findings, we only considered an IA volume increase of >20% after FD treatment as a true IA volume increase. RESULTS: During the follow-up period, 6 IAs increased in volume and 9 IAs did not. More patients presenting with mass effect-related symptoms showed IA expansion (6 of 10 IAs) compared with patients presenting with ischemia-related symptoms (0 of 5 IAs; Fisher's exact test, 2-sided; P = 0.044). CONCLUSION: The volume of large and giant IAs can increase in the first 6 months after FD treatment. More patients presenting with mass effect-related symptoms showed IA expansion than patients with ischemia-related symptoms.
OBJECTIVE:Patients with large and giant intracranial aneurysms (IAs) can experience neurological deterioration within 6 months after successful flow diverter (FD) placement. The purpose of the present study was to assess whether the occurrence of neurological deterioration can be linked to IA expansion within 6 months after FD treatment. METHODS: From 2010 to 2016, 45 FD procedures were performed in 44 patients with a large or giant IA. From this group, we selected all patients (14 patients with 15 IAs) with neurological deterioration within 6 months after FD treatment. All these patients had undergone follow-up imaging studies within the same period. The patients were then divided into 2 groups, those with mass effect-related and those with ischemia-related symptoms. The volumes of all treated IAs were determined through manual segmentation of the available pre- and postoperative imaging studies to determine IA expansion after FD treatment. To rule out false-positive findings, we only considered an IA volume increase of >20% after FD treatment as a true IA volume increase. RESULTS: During the follow-up period, 6 IAs increased in volume and 9 IAs did not. More patients presenting with mass effect-related symptoms showed IA expansion (6 of 10 IAs) compared with patients presenting with ischemia-related symptoms (0 of 5 IAs; Fisher's exact test, 2-sided; P = 0.044). CONCLUSION: The volume of large and giant IAs can increase in the first 6 months after FD treatment. More patients presenting with mass effect-related symptoms showed IA expansion than patients with ischemia-related symptoms.