Abstract
To clip or coil has been matter of debates for several years and is the domain of interdisciplinary decision making. However, the microsurgical outcome has still been elusive concerning wide neck aneurysms (WNA). A retrospective single center study was performed with all patients with ruptured WNA (rWNA) and unruptured WNA (uWNA) admitted to author´s institute between 2007–2017. Microsurgical outcome was evaluated according to Raymond-Roy occlusion grade and follow-up angiography was performed to analyze the stability of neck/aneurysm remnants and retreatment poverty. Of 805 aneurysms, 139 were rWNA (17.3%) and 148 uWNA (18.4%). Complete occlusion was achieved in 102 of 139 rWNA (73.4%) and 112 of 148 uWNA (75.6%). Neck remnants were observed in 36 patients with rWNA (25.9%) and 30 patients with uWNA (20.3%), 1 (0.7%) and 6 (4.1%) patients had aneurysmal remnant, respectively. Overall complication rate was 11.5%. At follow-up (939/1504 months), all remnants were stable except for one, which was further conservatively treated with marginal retreatment rate under 1%. Even the risk of de-novo aneurysm was higher than the risk for remnant growth (2.6% vs 0% in rWNA; 8.7% vs 5.3% in uWNA) without significant difference. Microsurgical clipping is effective for complete occlusion of r/uWNA with low complication. Furthermore, the risk of remnant growth is marginal even lower than the risk of de-novo rate low retreatment rate.
Highlights
To clip or coil has been matter of debates for several years and is the domain of interdisciplinary decision making
Similar results were reported in Barrow Ruptured Aneurysm Trial in the first year of follow-up, but at further follow up (3-/6- and recently 10 years), there was no difference in terms of patients outcome between those two modalities except higher recanalization and retreatment rate in the endovascular group resulting in an increased valuability of surgical treatment[3,4] both treatment modalities have its advantages and disadvantages and the decision for aneurysmal treatment is made by interdisciplinary consensus
We sought to analyze and complement the microsurgical outcome of ruptured and unruptured wide neck aneurysms (WNA) in order to answer the following questions: (1) How many ruptured and unruptured WNA are completely or adequately occluded? (2) Are the microsurgical treated WNAs stable at follow up or how are the rates of remnant growth compared to de-novo rate? (3) What are the factors for postoperative remnant?
Summary
To clip or coil has been matter of debates for several years and is the domain of interdisciplinary decision making. Even the risk of de-novo aneurysm was higher than the risk for remnant growth (2.6% vs 0% in rWNA; 8.7% vs 5.3% in uWNA) without significant difference. Similar results were reported in Barrow Ruptured Aneurysm Trial in the first year of follow-up, but at further follow up (3-/6- and recently 10 years), there was no difference in terms of patients outcome between those two modalities (especially in anterior circulation aneurysms) except higher recanalization and retreatment rate in the endovascular group resulting in an increased valuability of surgical treatment[3,4] both treatment modalities have its advantages and disadvantages and the decision for aneurysmal treatment is made by interdisciplinary consensus. (2) Are the microsurgical treated WNAs stable at follow up or how are the rates of remnant growth compared to de-novo rate? We sought to analyze and complement the microsurgical outcome of ruptured and unruptured WNA in order to answer the following questions: (1) How many ruptured and unruptured WNA are completely or adequately occluded? (2) Are the microsurgical treated WNAs stable at follow up or how are the rates of remnant growth compared to de-novo rate? (3) What are the factors for postoperative remnant?
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