Improved rates of postoperative ischemia, completeness of aneurysm occlusion and neurological deficits in elective clipping of anterior circulation aneurysms over the past 20 years – association with technical improvements

URN zum Zitieren dieses Dokuments:

urn:nbn:de:bvb:355-epub-584085 Copy

DOI zum Zitieren dieses Dokuments:

10.5283/epub.58408 Copy

Siller, Sebastian ; Briegel, Josef ; Kunz, Mathias ; Liebig, Thomas ; Forbrig, Robert ; Tonn, Joerg-Christian ; Schichor, Christian ; Thorsteinsdottir, Jun

Lizenz: Creative Commons Namensnennung 4.0 International PDF - Veröffentlichte Version (1MB)

Veröffentlichungsdatum dieses Volltextes: 11 Jun 2024 05:46

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Diese Publikation ist Teil des DEAL-Vertrags mit Springer.

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Details

Dokumentenart:	Artikel
Open Access Art:	DEAL (Springer)
Titel eines Journals oder einer Zeitschrift:	Acta Neurochirurgica
Verlag:	Springer
Band:	166
Nummer des Zeitschriftenheftes oder des Kapitels:	1
Datum:	7 Juni 2024
Institutionen:	Medizin > Lehrstuhl für Neurochirurgie
Identifikationsnummer:	Wert Typ 10.1007/s00701-024-06150-7 DOI
Stichwörter / Keywords:	Intracranial aneurysm · Anterior circulation · Clip occlusion · Outcome · Occlusion rate · Postoperative ischemic events
Dewey-Dezimal-Klassifikation:	600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin
Status:	Veröffentlicht
Begutachtet:	Ja, diese Version wurde begutachtet
An der Universität Regensburg entstanden:	Zum Teil
Dokumenten-ID:	58408

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Zusammenfassung

Background/Purpose Several periprocedural adjuncts for elective surgical aneurysm treatment have been introduced over the last 20 years to increase safety and efficacy. Besides the introduction of IONM in the late-1990s, ICG-videoangiography (ICG-VAG) since the mid-2000s and intraoperative CT-angiography/-perfusion (iCT-A/-P) since the mid-2010s are available. We aimed to clarify whether the ...

Zusammenfassung

Background/Purpose
Several periprocedural adjuncts for elective surgical aneurysm treatment have been introduced over the last 20 years to increase safety and efficacy. Besides the introduction of IONM in the late-1990s, ICG-videoangiography (ICG-VAG) since the mid-2000s and intraoperative CT-angiography/-perfusion (iCT-A/-P) since the mid-2010s are available. We aimed to clarify whether the introduction of ICG-VAG and iCT-A/-P resulted in our department in a stepwise improvement in the rate of radiologically detected postoperative ischemia, complete aneurysm occlusion and postoperative new deficits.
Methods
Patients undergoing microsurgical clip occlusion for unruptured anterior circulation aneurysms between 2000 and 2019 were included, with ICG-VAG since 2009 and iCT-A/-P (for selected cases) since 2016. Baseline characteristics and treatment-related morbidity/outcome focusing on differences between the three distinct cohorts (cohort-I: pre-ICG-VAG-era, cohort-II: ICG-VAG-era, cohort-III: ICG-VAG&iCT-A/-P-era) were analyzed.
Results
1391 patients were enrolled (n = 74 were excluded), 779 patients were interventionally treated, 538 patients were surgically clipped by a specialized vascular team (cohort-I n = 167, cohort-II n = 284, cohort-III n = 87). Aneurysm size was larger in cohort-I (8.9 vs. 7.5/6.8 mm; p < 0.01) without differences concerning age (mean:55years), gender distribution (m: f = 1:2.6) and aneurysm location (MCA:61%, ICA:18%, ACA/AcomA:21%). There was a stepwise improvement in the rate of radiologically detected postoperative ischemia (16.2vs.12.0vs.8.0%; p = 0.161), complete aneurysm occlusion (68.3vs.83.6vs.91.0%; p < 0.01) and postoperative new deficits (10.8vs.7.7vs.5.7%; p = 0.335) from cohort-I to -III. After a mean follow-up of 12months, a median modified Rankin scale of 0 was achieved in all cohorts.
Discussion
Associated with periprocedural technical achievements, surgical outcome in elective anterior circulation aneurysm surgery has improved in our service during the past 20 years.

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