Unruptured intracranial aneurysms: Comparison of perioperative complications, discharge disposition, outcome, and effect of calcification, between clipping and coiling: A single institution experience

Sharma, Mayur; Brown, B. L.; Madhugiri, Venkatesh S; Cuellar‐Saenz, Hugo; Sonig, Ashish; Ambekar, Sudheer; Nanda, Anil

doi:10.4103/0028-3886.115067

Cited by 29 publications

(18 citation statements)

References 29 publications

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“…In total, 5423 articles were screened, of which 114 articles met the eligibility criteria for this review (eFigure 1 and eTables 2-4 in the Supplement). For EVT, we included 74 studies that included 71 819 patients with 73 066 aneurysms (eTable 3 in the Supplement) and for NST, we included 54 studies with a total of 34 614 patients with 35 197 aneurysms (eTable 4 in the Supplement). Fourteen of 114 studies (12.3%), with a tot...…”

Section: Resultsmentioning

confidence: 99%

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Procedural Clinical Complications, Case-Fatality Risks, and Risk Factors in Endovascular and Neurosurgical Treatment of Unruptured Intracranial Aneurysms

et al. 2019

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IMPORTANCEThe risk of procedural clinical complications and the case-fatality rate (CFR) from preventive treatment of unruptured intracranial aneurysms varies between studies and may depend on treatment modality and risk factors. OBJECTIVE To assess current procedural clinical 30-day complications and the CFR from endovascular treatment (EVT) and neurosurgical treatment (NST) of unruptured intracranial aneurysms and risk factors of clinical complications.

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Section: Resultsmentioning

confidence: 99%

“…For EVT, we included 74 studies that included 71 819 patients with 73 066 aneurysms (eTable 3 in the Supplement) and for NST, we included 54 studies with a total of 34 614 patients with 35 197 aneurysms (eTable 4 in the Supplement). Fourteen of 114 studies (12.3%), with a total of 33 676 patients, reported on both EVT and NST.…”

Section: Resultsmentioning

confidence: 99%

Procedural Clinical Complications, Case-Fatality Risks, and Risk Factors in Endovascular and Neurosurgical Treatment of Unruptured Intracranial Aneurysms

et al. 2019

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“…Our results are in concordance with the recently published case series reporting 0.0–1.6% mortality and 6.2–9.4% morbidity for unruptured aneurysm clipping. [ 13 14 15 ] In their recent review, Bacigaluppi et al . reported that a comprehensive intraoperative monitoring during aneurysm surgery reduces ischemia-related morbidities.…”

Section: Discussionmentioning

confidence: 99%

“…Intra-operative premature rupturing is always a concern even at the hands of experienced neurovascular surgeons. [ 8 15 ] Such a mishap may lead to a catastrophe in endonasal corridor as the intense bleeding obscures the view and securing a proximal control is very difficult if not impossible. Furthermore, current endoscopes do not provide surgeons with enough magnification to do microdissection around the aneurysm whilst it is an absolute necessity to dissect the perforators off the neck.…”

Section: Discussionmentioning

confidence: 99%

Role of endoscopy in multi-modality monitoring during aneurysm surgery: A single center experience with 175 consecutive unruptured aneurysms

et al. 2015

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Objective and Background:Unruptured aneurysm surgery is a challenge to all vascular neurosurgeons as the patient is asymptomatic and no even slight neurological deficits should be expected postoperatively. To this aim, multi-modality checking of the vessels during the surgery is highly recommended to assure of the patency of the parent and perforator arteries next to an aneurysm. In this paper, we present our experience in the last 1.5 years with emphasis on the role of endoscope assisted microsurgery.Methods:One hundred and seventy-five patients with unruptured intracranial aneurysms were operated in our institute in the last 1½ years. All patients underwent endoscope assisted microsurgery with pre- and post-clipping indocyanine green angiography. In selected cases, motor evoked potential monitoring was implemented.Results:No mortality was observed in this period, and only 6 patients (3.4%) suffered new permanent neurological deficits postoperatively. Our illustrative cases show how endoscopy may help the surgeon to visualize hidden vessels behind and medial to an aneurysm.Conclusions:Our results indicated that multi-modality monitoring during unruptured aneurysm surgeries is associated with excellent outcome. Endoscope is able to show blind corners during aneurysm surgery which cannot be routinely observed with microscope and its application in aneurysm surgery assists the surgeon to make certain of complete neck clipping and preservation of perforating arteries around the aneurysm.

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“…However, since surgeons have readily adopted new endovascular techniques, enthusiasm for a trial studying unruptured aneurysms has been limited. Prior national retrospective studies 1,2,4–7,9,11,12,15–18,20,21,24,27–29,32,33,37,38 have inconclusive results and methodological limitations, with most authors failing to appropriately adjust for measured or unmeasured confounders.…”

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confidence: 99%

Comparison of clipping and coiling in elderly patients with unruptured cerebral aneurysms

Bekelis¹,

Gottlieb²,

Su³

et al. 2017

JNS

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OBJECTIVE The comparative effectiveness of the 2 treatment options—surgical clipping and endovascular coiling—for unruptured cerebral aneurysms remains an issue of debate and has not been studied in clinical trials. The authors investigated the association between treatment method for unruptured cerebral aneurysms and outcomes in elderly patients. METHODS The authors performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who had treatment for unruptured cerebral aneurysms between 2007 and 2012. To control for measured confounding, the authors used propensity score conditioning and inverse probability weighting with mixed effects to account for clustering at the level of the hospital referral region (HRR). An instrumental variable (regional rates of coiling) analysis was used to control for unmeasured confounding and to create pseudo-randomization on the treatment method. RESULTS During the study period, 8705 patients underwent treatment for unruptured cerebral aneurysms and met the study inclusion criteria. Of these patients, 2585 (29.7%) had surgical clipping and 6120 (70.3%) had endovascular coiling. Instrumental variable analysis demonstrated no difference between coiling and clipping in 1-year postoperative mortality (OR 1.25, 95% CI 0.68–2.31) or 90-day readmission rate (OR 1.04, 95% CI 0.66–1.62). However, clipping was associated with a greater likelihood of discharge to rehabilitation (OR 6.39, 95% CI 3.85–10.59) and 3.6 days longer length of stay (LOS; 95% CI 2.90–4.71). The same associations were present in propensity score–adjusted and inverse probability– weighted models. CONCLUSIONS In a cohort of Medicare patients, there was no difference in mortality and the readmission rate between clipping and coiling of unruptured cerebral aneurysms. Clipping was associated with a higher rate of discharge to a rehabilitation facility and a longer LOS.

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Unruptured intracranial aneurysms: Comparison of perioperative complications, discharge disposition, outcome, and effect of calcification, between clipping and coiling: A single institution experience

Abstract: With appropriate patient selection, the majority of the UIAs can be managed by either of the treatment modalities with very low mortality and morbidity. Both the treatment modalities should be employed synergistically.

Cited by 29 publications

References 29 publications

Procedural Clinical Complications, Case-Fatality Risks, and Risk Factors in Endovascular and Neurosurgical Treatment of Unruptured Intracranial Aneurysms

Procedural Clinical Complications, Case-Fatality Risks, and Risk Factors in Endovascular and Neurosurgical Treatment of Unruptured Intracranial Aneurysms

Role of endoscopy in multi-modality monitoring during aneurysm surgery: A single center experience with 175 consecutive unruptured aneurysms

Comparison of clipping and coiling in elderly patients with unruptured cerebral aneurysms

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