Evaluation of Microsurgery for Managing Giant or Complex Cerebral Aneurysms: A Retrospective Study

• Published in: World neurosurgery 2018-07, Vol.115, p.e190-e199
• Main Authors: Ota, Nakao, Matsukawa, Hidetoshi, Noda, Kosumo, Sato, Hirotaka, Hatano, Yuto, Hashimoto, Atsumu, Miyazaki, Takanori, Kondo, Tomomasa, Kinoshita, Yu, Saito, Norihiro, Kamiyama, Hiroyasu, Tokuda, Sadahisa, Kamada, Kyousuke, Tanikawa, Rokuya
• Format: Article
• Language: English
• Subjects: Basilar artery aneurysm; Bypass surgery; Complex aneurysm; Dolichoectatic basilar aneurysm; Giant aneurysm
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.04.007

Surgical or endovascular treatment for giant or complex aneurysms is challenging. The aims of this study were to evaluate clinical outcomes and factors affecting the prognosis of giant or complex aneurysms and to better establish the role of microsurgery in the management strategy. One hundred fifty-nine patients with surgically treated complex aneurysms were included. Thirty-two patients (20.1%) had giant aneurysms (≥25 mm) and 57 (35.8%) had large aneurysms (≥15 mm). Poor outcome was defined as modified Rankin Scale scores of 3–6. The mean aneurysm size was 17.0 mm (range, 1.6–47.5 mm). One hundred and sixteen aneurysms (80.0%) were in the anterior circulation and 43 (27.0%) were in the posterior circulation. One hundred and thirty-eight (86.8%) aneurysms were completely occluded without residual aneurysms. Nineteen (11.9%) had minor aneurysm remnants; 2 (1.3%) had incomplete occlusion. Two patients (1.3%) with giant basilar artery (BA) trunk aneurysms experienced rupture of the treated aneurysm and died. Bypass surgery was combined with microsurgery in 148 patients (93.1%). Perforating artery infarction was observed postoperatively in 42 patients (26.4%), and poor outcome was observed in 29 (18.2%). Male sex (P = 0.016; adjusted odds ratio [OR], 4.524 [1.949–10.500]), perforating artery infarction (P < 0.001; adjusted OR, 13.625 [5.329–34.837]), and BA aneurysm location (P = 0.003; adjusted OR, 56.333 [6.830–464.657]) were significantly related to poor outcome. The aneurysm size (P = 0.017; adjusted OR, 1.064 [1.021–1.107]), C1 aneurysm location (P = 0.042; adjusted OR, 2.591 [0.986–6.811]), and BA aneurysm location (P = 0.033; adjusted OR, 12.956 [3.197–52.505]) were significantly related to perforating artery infarction. Microsurgery with bypass is effective for many different complex aneurysms, except BA aneurysms. •159 patients with surgically treated complex aneurysms were included.•138 (86.8%) aneurysms were completely occluded without residual aneurysms.•Perforating artery infarction was observed postoperatively in 42 patients (26.4%). Poor outcome was observed in 29 (18.2%).•Male sex, perforating artery infarction, and BA aneurysm location were significantly related to poor outcome.•The aneurysm size, C1 aneurysm, and BA aneurysm location were significantly related to perforating artery infarction.