Julien Haemmerli1,2, Pavlina Lenga3, Bujung Hong4, Adisa Kursumovic5, Nicolai Maldaner6, Jan-Karl Burkhardt6, Philippe Bijlenga7, Daniel A Rüfenacht8, Nils-Ole Schmidt9, Peter Vajkoczy3, Julius Dengler3,10,11. 1. Department of Neurosurgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany. Julien.haemmerli@hcuge.ch. 2. Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland. Julien.haemmerli@hcuge.ch. 3. Department of Neurosurgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany. 4. Department of Neurosurgery, Hannover Medical School, Hanover, Germany. 5. Department of Neurosurgery and Interventional Neuroradiology, Donauisar Klinikum Deggendorf, Deggendorf, Germany. 6. Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland. 7. Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland. 8. Department of Neuroradiology, Hirslanden Clinic, Zurich, Switzerland. 9. Department of Neurosurgery, University Medical Center, Eppendorf, Hamburg, Germany. 10. Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany. 11. Department of Neurosurgery, Helios Clinic, Bad Saarow, Germany.
Abstract
BACKGROUND: Giant intracranial aneurysms of the posterior circulation (GPCirA) are rare entities compressing the brainstem and adjacent structures. Previous evidence has shown that the amount of brainstem shift away from the cranial base is not associated with neurological deficits. This raises the question whether other factors may be associated with neurological deficits. METHODS: All data were extracted from the Giant Intracranial Aneurysm Registry, an international multicenter prospective study on giant intracranial aneurysms. We grouped GPCirA according to the mass effect on the brainstem (lateral versus medial). Brainstem compression was evaluated with two indices: (a) brainstem compression ratio (BCR) or diameter of the compressed brainstem to the assumed normal diameter of the brainstem and (b) aneurysm to brainstem ratio (ABR) or diameter of the aneurysm to the diameter of the compressed brainstem. We examined associations between neurological deficits and GPCirA characteristics using binary regression analysis. RESULTS: Twenty-eight GPCirA were included. Twenty GPCirA showed medial (71.4%) and 8 lateral compression of the brainstem (28.6%). Baseline characteristics did not differ between the groups for patient age, aneurysm diameter, aneurysm volume, modified Rankin Scale (mRS), motor deficit (MD), or cranial nerve deficits (CND). Mean BCR was 53.0 in the medial and 54.0 in the lateral group (p = 0.92). The mean ABR was 2.9 in the medial and 2.3 in the lateral group (p = 0.96). In the entire cohort, neither BCR nor ABR nor GPCirA volumes were associated with the occurrence of CND or MD. In contrast, disability (mRS) was significantly associated with ABR (OR 1.94 (95% CI 1.01-3.70; p = 0.045) and GPCirA volumes (OR 1.21 (95% CI 1.01-1.44); p = 0.035), but not with BCR. CONCLUSION: In this cohort of patients with GPCirA, neither the degree of lateral projection nor the amount of brainstem compression predicted neurological deficits. Disability was associated only with aneurysm volume. When designing treatment strategies for GPCirA, aneurysm laterality or the amount of brainstem compression should be viewed as less relevant while the high risk of rupture of such giant lesions should be emphasized. TRIAL REGISTRATION: The registry is listed at clinicaltrials.gov under the registration no. NCT02066493.
BACKGROUND:Giant intracranial aneurysms of the posterior circulation (GPCirA) are rare entities compressing the brainstem and adjacent structures. Previous evidence has shown that the amount of brainstem shift away from the cranial base is not associated with neurological deficits. This raises the question whether other factors may be associated with neurological deficits. METHODS: All data were extracted from the Giant Intracranial Aneurysm Registry, an international multicenter prospective study on giant intracranial aneurysms. We grouped GPCirA according to the mass effect on the brainstem (lateral versus medial). Brainstem compression was evaluated with two indices: (a) brainstem compression ratio (BCR) or diameter of the compressed brainstem to the assumed normal diameter of the brainstem and (b) aneurysm to brainstem ratio (ABR) or diameter of the aneurysm to the diameter of the compressed brainstem. We examined associations between neurological deficits and GPCirA characteristics using binary regression analysis. RESULTS: Twenty-eight GPCirA were included. Twenty GPCirA showed medial (71.4%) and 8 lateral compression of the brainstem (28.6%). Baseline characteristics did not differ between the groups for patient age, aneurysm diameter, aneurysm volume, modified Rankin Scale (mRS), motor deficit (MD), or cranial nerve deficits (CND). Mean BCR was 53.0 in the medial and 54.0 in the lateral group (p = 0.92). The mean ABR was 2.9 in the medial and 2.3 in the lateral group (p = 0.96). In the entire cohort, neither BCR nor ABR nor GPCirA volumes were associated with the occurrence of CND or MD. In contrast, disability (mRS) was significantly associated with ABR (OR 1.94 (95% CI 1.01-3.70; p = 0.045) and GPCirA volumes (OR 1.21 (95% CI 1.01-1.44); p = 0.035), but not with BCR. CONCLUSION: In this cohort of patients with GPCirA, neither the degree of lateral projection nor the amount of brainstem compression predicted neurological deficits. Disability was associated only with aneurysm volume. When designing treatment strategies for GPCirA, aneurysm laterality or the amount of brainstem compression should be viewed as less relevant while the high risk of rupture of such giant lesions should be emphasized. TRIAL REGISTRATION: The registry is listed at clinicaltrials.gov under the registration no. NCT02066493.
Authors: G Durner; M Piano; P Lenga; D Mielke; C Hohaus; S Guhl; N Maldaner; J K Burkhardt; M T Pedro; J Lehmberg; D Rufenacht; P Bijlenga; N Etminan; J K Krauss; E Boccardi; D Hänggi; P Vajkoczy; Julius Dengler Journal: Acta Neurochir (Wien) Date: 2018-06-09 Impact factor: 2.216
Authors: Julius Dengler; Nicolai Maldaner; Philippe Bijlenga; Jan-Karl Burkhardt; Alexander Graewe; Susanne Guhl; Bujung Hong; Christian Hohaus; Adisa Kursumovic; Dorothee Mielke; Karl-Michael Schebesch; Maria Wostrack; Daniel Rufenacht; Peter Vajkoczy; Nils Ole Schmidt Journal: J Neurosurg Date: 2015-04-17 Impact factor: 5.115