Long-term functional outcome of symptomatic unruptured intracranial aneurysms in an interdisciplinary treatment concept

• Published in: World neurosurgery 2017-09, Vol.105, p.849-856
• Main Authors: Kunz, M, Dorn, F, Greve, T, Stoecklein, V, Tonn, J.C, Brückmann, H, Schichor, Ch
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Brainstem compression; Cerebral Angiography - methods; Cranial nerve compression; Embolization, Therapeutic - methods; Endovascular Procedures - methods; Female; Functional outcome; Humans; Interdisciplinary treatment; Intracranial Aneurysm - surgery; Intracranial Aneurysm - therapy; Long-term results; Male; Microsurgery - methods; Middle Aged; Neurosurgery; Recovery of Function - physiology; Symptomatic UIAs; Time; Treatment Outcome; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.06.028

Abstract Objective In symptomatic unruptured intracranial aneurysms (UIA), data on long-term functional outcome are sparse in the literature, even in the light of modern interdisciplinary treatment decisions. We therefore analysed our in-house database for prognostic factors and long-term outcome of neurological symptoms after microsurgical/endovascular treatment. Methods Patients treated between 2000 and 2016 after interdisciplinary vascular board decision were included. UIAs were categorized as symptomatic in case of cranial nerve or brainstem compression. Symptoms were categorized as mild/severe. Long-term development of symptoms after treatment was assessed in a standardized and independent fashion. Results Of 98 symptomatic UIAs (microsurgery/endovascular 43/55) 84 patients presented with cranial nerve (NII-VI) compression and 14 patients with brainstem compression symptoms. Permanent morbidity occurred in 9% of patients. Of 119 symptoms (mild/severe 71/48), 60.4% recovered (full/partial 22%/39%) and 29% stabilized till last follow-up; median follow-up was 19.5 months. Symptom recovery was higher in long-term compared to that at discharge (p=0.002). Optic nerve compression symptoms were less likely to improve compared to abducens nerve palsies and brainstem compression. Prognostic factors for recovery were duration and severity of symptoms, treatment modality (microsurgery) and absence of ischemia in the multivariate analysis. Conclusions The recent study presents for the first time a detailed analysis of relevant prognostic factors for long-term recovery of cranial nerve/brainstem compression symptoms in an interdisciplinary treatment concept, which was excellent in the majority of patients–with lowest recovery rates in optic nerve compression. Symptom recovery was remarkably higher at long-term compared to recovery at discharge.