Clipping of very large or giant unruptured intracranial aneurysms in the anterior circulation: an outcome study

Hauck, Erik F.; Wohlfeld, Bryan J; Welch, Babu G.; White, Jonathan A.; Samson, Duke

doi:10.3171/jns.2008.109.12.1012

Cited by 67 publications

(36 citation statements)

References 22 publications

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“…They also mentioned that these age ranges typically present with a baseline disability and more comorbidities (p <0.05) associated with dependence than the younger age group. 17 Our results also showed that poor neurological grade had significant association with outcome following surgical obliteration of giant aneurysms. The result of the uni-and multivariate analysis showed the association between the H&H grade and GOS (p <0.001).…”

Section: Poor Neurological Gradesupporting

confidence: 63%

“…25 mm, and occurrence of either an ischemic or hemorrhagic stroke. 17 In Orz et al's study on 310 patients with unruptured aneurysms, aneurysm size Figure 1 Bar chart depicting the distribution of Glasgow Outcome Scale score of the patients with giant aneurysms in anteriorly located lesions. …”

Section: Discussionmentioning

confidence: 99%

“…It can also be used for thrombectomy and lesion decompression; however, in Hauck et al's series, the results were not significantly better than simple clipping. 17 Size of aneurysm has been shown to have a significant effect on the outcome following clipping but not after endovascular treatment. 43 …”

Section: Treatment Modalitiesmentioning

confidence: 99%

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Evaluation of the Prognostic Indicators of Giant Intracranial Aneurysms

Vannemreddy¹,

Nourbakhsh²,

Nanda³

2010

Skull Base

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The indicators of poor outcome in giant intracranial aneurysms have been the subject of several studies in the literature. We conducted a retrospective analysis to evaluate the predictors of poor outcome in giant intracranial aneurysms. We studied consecutive cases with aneurysms admitted over a 9-year period in our institution. All the aneurysms were treated with clipping. Patient demographics, clinical profile, and aneurysm characteristics were evaluated in a multivariate analysis as probable indicators of Glasgow Outcome Scale (GOS) score. The outcome of the aneurysms (GOS score) was compared with the remaining non-giant aneurysms. A total of 41 giant and 348 non-giant aneurysms were identified in our series. In the multivariate analysis, the indicators of poor outcome were identified as poor clinical grade (p <0.0004), intraoperative rupture (p <0.007), and posterior circulation of the aneurysms (p <0.01). Non-giant aneurysms had a better outcome compared with the giant aneurysms (p <0.01). Giant aneurysms impose a relatively higher risk of morbidity and mortality to the patients. The predictors of the postsurgical outcome of the giant aneurysms include the clinical condition of the patient, location of the aneurysm, and intraoperative rupture.

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Section: Poor Neurological Gradesupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Prognostic Indicators of Giant Intracranial Aneurysms

Vannemreddy¹,

Nourbakhsh²,

Nanda³

2010

Skull Base

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“…Unfortunately, in that respect, most recent publications consist of endovascular series, and site-specific series comparing coiling versus clipping for cerebral aneurysms. 2,4,5,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]27,31,32, While these comparisons between competing techniques are obviously expected to occur, we feel that, as endovascular treatment for aneurysms continues to evolve and find its definite place in the therapeutic armamentarium, its proven benefits are best weighed in a multidisciplinary, complementary approach. We have experienced the benefits of this therapeutic philosophy as the natural evolution of a collaborative approach to these complex lesions from all possible therapeutic approaches to improve our patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Treatment Strategies for Complex Intracranial Aneurysms: Review of a 10-Year Experience at the University of Cincinnati

Andaluz¹,

Zuccarello²

2009

Skull Base

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Complex intracranial aneurysms (CIAs) include those classified as giant, those located in brain regions of technically difficult access, or that involve arterial trunks/ branches, and/or have complicated wall structure. We reviewed retrospectively our management of such lesions in a 12-year period. From 1997From to 2009 patients were admitted with CIAs (133 females, 59 males; average age 55 years); 128 presented with subarachnoid hemorrhage (SAH) and 64 with unruptured, symptomatic CIAs. The SAH group had 73 anterior-and 55 posterior-circulation aneurysms. Most frequent location was middle cerebral artery. Treatment strategies included clipping (65.6%), coiling/stenting (28.1%), bypass (3.1%), no treatment (3.1%). Coiling/stenting was exclusively used for posterior-circulation aneurysms. Outcomes were good (modified Rankin Scale [mRS] 0 to 2) in 54 patients (42.2%), fair (mRS ¼ 3 to 4) in 38 (29.7%), and poor (mRS ¼ 5 to 6) in 36 (28.1%). Among unruptured CIAs, there were 47 anterior-and 17 posterior-circulation aneurysms. Most frequent location was ophthalmic. Thirty (46.9%) were clipped, 19 (29.7%) coiled, 6 (9.4%) by-passed, 2 (3.1%) wrapped, and 7 (10.9%) had no treatment. Outcomes were good in 57 patients (89%) and fair in 7 (11%). Good outcomes were obtained in unruptured CIAs using a multidisciplinary approach. Ruptured CIAs carry a significantly worse prognosis than overall SAH patients.

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“…Als Konsequenz besteht ein anhaltendes Risiko für eine Ruptur, weitere Behandlungen können erforderlich werden [4]. In etwa 3-9% kann es zu einem Verschluss oder einer relevanten Einengung benachbarter Gefäße mit der Gefahr eines Hirninfarkts und bleibenden neurologischen Defiziten kommen [2,8].…”

Section: -73% Aller Mikrochirurgisch Versorgterunclassified

Rekonstruktionsoptimierung und Leistungsfähigkeit eines neurochirurgisch eingesetzten intraoperativen Flat-Panel-Systems

Röhrer¹,

König²,

Wirtz³

et al. 2015

OP-JOURNAL

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Zusammenfassung Die digitale Subtraktionsangiografie stellt den Goldstandard in der vaskul?ren Neurochirurgie dar. Durch die Anwendung einer intraoperativen Angiografie, welche durch den Hybridoperationssaal mit dem System Artis zeego m?glich ist, kann diese Kontrolle noch w?hrend der Operation, bei ge?ffnetem Sch?del durchgef?hrt werden. Unterschiedliche 2-D- und 3-D-Darstellungsm?glichkeiten der akquirierten Bilddaten machen es dem Operateur m?glich, die operative Strategie den daraus resultierenden Befunden ggf. anzupassen.

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Clipping of very large or giant unruptured intracranial aneurysms in the anterior circulation: an outcome study

Cited by 67 publications

References 22 publications

Evaluation of the Prognostic Indicators of Giant Intracranial Aneurysms

Evaluation of the Prognostic Indicators of Giant Intracranial Aneurysms

Treatment Strategies for Complex Intracranial Aneurysms: Review of a 10-Year Experience at the University of Cincinnati

Rekonstruktionsoptimierung und Leistungsfähigkeit eines neurochirurgisch eingesetzten intraoperativen Flat-Panel-Systems

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