Clip ligation of unruptured intracranial aneurysms: a prospective midterm outcome study

• Published in: Acta neurochirurgica 2012-07, Vol.154 (7), p.1135-1144
• Main Authors: Aydın, Yunus, Çavuşoğlu, Halit, Kahyaoğlu, Okan, Müslüman, Ahmet Murat, Yılmaz, Adem, Türkmenoğlu, Osman Nuri, Can, Songül Meltem, Yüce, İsmail
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aneurysm; Angiography; Angiography, Digital Subtraction; Cerebral Angiography; Cerebrovascular diseases; Clinical Article; Craniotomy - methods; Disability Evaluation; Female; Follow-Up Studies; Hemorrhage; Humans; Interventional Radiology; Intracranial Aneurysm - diagnosis; Intracranial Aneurysm - surgery; Ischemia; Ligation - methods; Magnetic Resonance Angiography; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Mortality; Neurology; Neuroradiology; Neurosurgery; Occlusion; Patient Selection; Postoperative Complications - diagnosis; Prospective Studies; Stroke; Surgery; Surgical Instruments; Surgical Orthopedics; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-012-1397-y

Background We conducted a prospective study to investigate the clinical and radiological outcome in a surgical case series of 176 patients with 203 unruptured intracranial aneurysms (UIA). Methods The success of aneurysm obliteration was assessed within 2 weeks after surgery by digital subtraction angiography (DSA). Patients also underwent angiography 5 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 mortality rate was 0 % overall. 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 aneurysms. Sixty percent of treated aneurysms were checked with late follow-up DSA. No cases of hemorrhage from a surgically obliterated UIA were documented in this series during the 7.3 ± 1.4 (SD)-year follow-up period. Conclusions If patients are carefully selected and individually assigned to their optimum treatment modality, IUAs can be obliterated by surgery with a low percentage of unfavorable outcomes.