Factors Affecting the Outcome of Multiple Intracranial Aneurysm Surgery

Anas Abdallah; Murad Asiltürk; Erhan Emel; Betül Güler Abdallah

doi:10.1055/s-0038-1668493

Indian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2018; 07(02): 116-121
DOI: 10.1055/s-0038-1668493

Original Article

Thieme Medical and Scientific Publishers Private Ltd.

Factors Affecting the Outcome of Multiple Intracranial Aneurysm Surgery

Anas Abdallah

¹Department of Neurosurgery, Bezmialem Vakif University, Istanbul, Turkey

^*Drs. Abdallah and Asiltürk contributed equally to this work.

,

Murad Asiltürk

²Department of Neurosurgery, University of Health Science, Bakırköy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry, Istanbul, Turkey

^*Drs. Abdallah and Asiltürk contributed equally to this work.

,

Erhan Emel

²Department of Neurosurgery, University of Health Science, Bakırköy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry, Istanbul, Turkey

,

Betül Güler Abdallah

³Department of Neurology-Intensive Care Unit, University of Health Science, Bakırköy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry, Istanbul, Turkey

› Author Affiliations

Abstract

Objectives Multiple intracranial aneurysms (MIAs) are fairly common entities. Unless MIAs are incidentally diagnosed, they remain asymptomatic until they rupture. In this study, the authors investigated factors affecting the surgical outcomes in patients with MIA by evaluating the surgical outcomes of 90 consecutive cases.

Material and Methods Medical records were retrospectively reviewed for 409 consecutive cerebral aneurysm cases that underwent surgery in the hospital from 2011 to 2013. The patients’ data were prospectively collected. All MIA patients (n = 90) constituted the core sample for this study.

Results The authors detected 221 aneurysms in 90 patients (49 females and 41 males; mean age: 50.8 ± 11.9 years; range: 25–82 years). Of the patients, 67 presented with subarachnoid hemorrhage, whereas 23 were incidentally diagnosed with unruptured aneurysms. The mortality rate was 13.3% (n = 12). The morbidity rate was 18.8% (n = 17). Of the patients, 67.8% (n = 61) had returned to their jobs and normal daily activities by their last follow-up (average: 52.3 months). History of coronary artery diseases (CADs) and low neurologic grade at presentation (Hunt-Hess grade 4/5) are independent risk factors for increasing morbidity and mortality in patients with MIA (odds ratio [OR]: 18.46; p = 0.007); (OR: 30.0; p = 0.002) and (OR: 0.06; p = 0.0001); (OR: 0.07; p = 0.002), respectively.

Conclusion History of CADs and high Hunt-Hess grade are independent risk factors for poor surgical outcomes of patients with MIA.

Keywords

clipping microsurgical - coronary artery disease - multiple intracranial aneurysm

Full Text

References

References
1 Broderick JP, Viscoli CM, Brott T. et al; Hemorrhagic Stroke Project Investigators. Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable. Stroke 2003; 34 (06) 1375-1381
2 Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G. European Stroke Organization. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 2013; 35 (02) 93-112
3 Rinkel GJ, Djibuti M, Algra A, van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 1998; 29 (01) 251-256
4 Baumann F, Khan N, Yonekawa Y. Patient and aneurysm characteristics in multiple intracranial aneurysms. Acta Neurochir Suppl (Wien) 2008; 103: 19-28
5 Juvela S. Risk factors for multiple intracranial aneurysms. Stroke 2000; 31 (02) 392-397
6 Kaminogo M, Yonekura M, Shibata S. Incidence and outcome of multiple intracranial aneurysms in a defined population. Stroke 2003; 34 (01) 16-21
7 Nieuwkamp DJ, Setz LE, Algra A, Linn FH, de Rooij NK, Rinkel GJ. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol 2009; 8 (07) 635-642
8 Asiltürk M, Abdallah A. Clinical outcomes of multiple aneurysms microsurgical clipping: evaluation of 90 patients. Neurol Neurochir Pol 2018; 52 (01) 15-24
9 Rinne J, Hernesniemi J, Niskanen M, Vapalahti M. Management outcome for multiple intracranial aneurysms. Neurosurgery 1995; 36 (01) 31-37 discussion 37–38
10 Pickard JD, Murray GD, Illingworth R. et al. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ 1989; 298 6674 636-642
11 Rosengart AJ, Huo JD, Tolentino J. et al. Outcome in patients with subarachnoid hemorrhage treated with antiepileptic drugs. J Neurosurg 2007; 107 (02) 253-260
12 Alg VS, Sofat R, Houlden H, Werring DJ. Genetic risk factors for intracranial aneurysms: a meta-analysis in more than 116,000 individuals. Neurology 2013; 80 (23) 2154-2165
13 Ajiboye N, Chalouhi N, Starke RM, Zanaty M, Bell R. Unruptured cerebral aneurysms: evaluation and management. Sci World J 2015; 2015: 954954
14 Backes D, Vergouwen MD, Velthuis BK. et al. Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms. Stroke 2014; 45 (05) 1299-1303
15 Wermer MJ, van der Schaaf IC, Velthuis BK, Algra A, Buskens E, Rinkel GJ. ASTRA Study Group. Follow-up screening after subarachnoid haemorrhage: frequency and determinants of new aneurysms and enlargement of existing aneurysms. Brain 2005; 128 Pt 10 2421-2429
16 Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28 (01) 14-20
17 Frontera JA, Claassen J, Schmidt JM. et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery 2006; 59 (01) 21-27 discussion 21–27
18 Jiménez-Roldán L, Alén JF, Gómez PA. et al. Volumetric analysis of subarachnoid hemorrhage: assessment of the reliability of two computerized methods and their comparison with other radiographic scales. J Neurosurg 2013; 118 (01) 84-93
19 Longstreth Jr WT, Nelson LM, Koepsell TD, van Belle G. Cigarette smoking, alcohol use, and subarachnoid hemorrhage. Stroke 1992; 23 (09) 1242-1249
20 Juvela S, Hillbom M, Numminen H, Koskinen P. Cigarette smoking and alcohol consumption as risk factors for aneurysmal subarachnoid hemorrhage. Stroke 1993; 24 (05) 639-646
21 Feigin VL, Rinkel GJ, Lawes CM. et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke 2005; 36 (12) 2773-2780
22 Kissela BM, Sauerbeck L, Woo D. et al. Subarachnoid hemorrhage: a preventable disease with a heritable component. Stroke 2002; 33 (05) 1321-1326