Safety and Efficacy of Surgical Treatment of Intracranial Aneurysms: The Experience of a Single Brazilian Center

Dellaretti, Marcos; Ronconi, Daniel; Batista, Danilo Malta; Souza, Renata Ferreira de; Almeida, Carlos Eduardo Romeu de; Fontoura, Renato Rinco; Antunes, Paulo Ramos Botelho; Quadros, Ricardo Sousa

doi:10.1016/j.wneu.2018.06.091

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…For endovascular UIA therapy, there is recent information given by Kallmes [16] who described in an international retrospective multicenter study mortality after stent embolizations as 3.8% and with giant aneurysms as 10.9%.and others [6,22]. Although the capacity of microsurgery to reconstruct vessel walls is known to be higher than from endovascular tools, publications indicate that there is a significant rate of incomplete aneurysm occlusions even after surgical treatment (Dellaretti as 10.2%, Nussbaum as 8%, and Nanda as 6% [11,23,24]). Our surgical occlusion rate of 92% is well comparable to these data.…”

Section: Resultsmentioning

confidence: 99%

Microsurgical and endovascular treatment of un-ruptured cerebral aneurysms by European hybrid neurosurgeons to balance surgical skills and medical staff management

et al. 2021

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Background In Europe, aneurysm treatment performed by dually trained neurosurgeons is extremely scarce. We provide outcome data for un-ruptured aneurysm patients treated at a European hybrid center to prove that hybrid neurosurgeons achieve clinical and angiographical results allowing to integrate hybrid neurosurgery into routine aneurysm treatment. This will not only help to maintain neurovascular microsurgical skills but will influence staff costs in related hospitals. Methods We retrospectively analyzed all consecutively treated un-ruptured aneurysm patients between 2000 and 2016. The decision-making took into account the pros and cons of both modalities and considered patient and aneurysm characteristics. Clinical outcome was assessed by the modified Rankin scale (mRS). Occlusion rates were stratified into grade I for 100%, grade II for 99–90%, and grade III for <90% occlusion. To account for the introduction of stents, two treatment periods (p1, 2000 to 2008; p2, 2009 to 2016) were defined. Results The study population consisted of 274 patients (median age 55 years) harboring 338 un-ruptured aneurysms. Microsurgery (MS) was performed in 51.8% and endovascular therapy (EVT) in 43.1%; 5.1% required combined treatment. Overall, 93% showed a favorable clinical outcome (mRS 0–2), 94.3% after MS and 91.5% after EVT. Grade I aneurysm occlusion was achieved in 82.6% patients, 91.9% after MS and 72.9% after EVT. Procedure-related complications occurred after MS in 5.6% and after EVT in 4.4% patients. Mortality was recorded for five (1.8%) patients, one patient after MS and four after EVT. For the EVT cohort, significant improvement from p1 to p2 was seen with clinical outcomes (P=0.030, RR = 0.905, CI: 0.8351–0.9802) and occlusion rates (P=0.039, RR = 0.6790, CI: 0.499–0.923). Conclusion Hybrid neurosurgeons achieve qualified clinical and angiographic results. Dual training will allow to maintain neurovascular caseloads and preserve future aneurysm treatment within neurosurgery. Furthermore economic benefits could be observed in hospital management.

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Section: Resultsmentioning

confidence: 99%

Microsurgical and endovascular treatment of un-ruptured cerebral aneurysms by European hybrid neurosurgeons to balance surgical skills and medical staff management

et al. 2021

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“…Moreover, there is the question of the UCAS not being relevant for populations outside Japan. There are still centers that recommend treatment for all small aneurysms possessing risk of developing SAH, the presence of a daughter sack or multiple aneurysms [78,104]. After the ISAT was published, endovascular techniques gained a boost in popularity in the USA for both ruptured and unruptured aneurysms, overtaking surgical treatment in number of procedures performed [105].…”

Section: Clipping Of Solitary Unruptured Aneurysmsmentioning

confidence: 99%

“…Aneurysmal rest (or dog ear) occurs when a small triangular portion of the neck is not occluded by the aneurysmal blades. In time, and under certain hemodynamic conditions, this residual neck can lead to aneurysm regrowth, and eventual rupture, requiring further imaging studies and possibly another intervention [104]. In the microsurgical series described by Nanda, the majority of recurrences were found at the ACoA, followed by ICA, VA, and PICA [163].…”

Section: Complications Of Surgical Clippingmentioning

confidence: 99%

Preventing Rupture: Clipping of Unruptured Intracranial Aneurysms

Florian¹,

Aldea²,

Florian³

2020

New Insight Into Cerebrovascular Diseases - An Updated Comprehensive Review

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Unruptured intracranial aneurysms (UIAs) represent a major public health issue due to their unpredictable natural history. Whether to actively treat them or to maintain them under observation remains a hotly disputed topic. In this chapter, we present a review of the literature regarding the history of clipping and its use in UIAs, as well as the experience of our senior author in this field. We performed an extensive Medline and Google Academic search of the relevant literature. We have also made a retrospective analysis on patients harboring UIAs and multiple intracranial aneurysms (MIAs) clipped by the senior author between 1997 and 2017. About 89 patients had solitary UIAs, alongside 101 with MIAs possessing 257 individual aneurysms in total. All UIA patients were discharged with a favorable neurological outcome and no mortality. Concerning MIAs, the majority of cases had 2 aneurysms, the highest number being 6. And, 61 patients from this group had a favorable outcome. In the hands of experienced vascular neurosurgeons, clipping remains a safe option for both UIAs and MIAs. This procedure offers a long-lasting protection from aneurysmal rupture. In the future, new clip technologies and intraprocedural methods of verifying vessel patency and aneurysmal occlusion may further enhance postoperative results.

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