Neurosurgical Review

, Volume 36, Issue 4, pp 567–572 | Cite as

Long-term prognosis in patients with clipped unruptured cerebral aneurysms―increased cerebrovascular events in patients with surgically treated unruptured aneurysms

  • Masaaki Hokari
  • Satoshi Kuroda
  • Naoki Nakayama
  • Kiyohiro Houkin
  • Tatsuya Ishikawa
  • Hiroyasu Kamiyama
Original Article
First Online:
Received:
Revised:
Accepted:

Abstract

We retrospectively investigated surgical immediate and long-term overall results after clipping of the unruptured aneurysms. Between 1991 and 2008, 166 patients underwent neck clipping of unruptured saccular aneurysms at our institute. Patients were subsequently followed to clarify the occurrence of subarachnoid hemorrhage (SAH), and stroke other than SAH, aneurysm recurrence, cerebrovascular death, all-cause death, and risk factors. Surgical complication was noted in 14 patients (8.4 %) and surgical morbidity in two patients (1.2 %). Of 164 patients except for these two patients who suffered surgical morbidity, we could obtain more than 3 years follow-up information for 144 patients (87.8 %). There were 49 men and 95 women. The mean age was 58.5 years, and mean follow-up period was 7.9 years. Eight cases had died during follow-up (hepatic insufficiency in one, renal insufficiency in one, suicide in one, intracerebral hemorrhage (ICH) in two, SAH in one, and pneumonia after stroke in two). Therefore, the cause of death was stroke and late effects of stroke. Twelve symptomatic cerebrovascular events (cerebral infarction in seven, ICH in four, and SAH in one) occurred in ten patients. Consequently, annual risk of SAH after clipping of unruptured aneurysms was 0.085 %. Besides, annual risk of stroke in those patients was 1.06 %, and this incidence was higher than that in the general population. Although this study confirmed the good surgical result, annual risk of stroke after clipping of unruptured aneurysms was much higher than that in the general population. The long-term periodic examination to detect recurrent aneurysms and appropriate management to prevent stroke should be performed for patients with surgically treated unruptured aneurysm.

Keywords

Long-term prognosis Clipping Unruptured cerebral aneurysms Stroke 
This is a preview of subscription content, log in to check access.

Notes

Conflict of Interest

There is no conflict of interest to report.

References

  1. 1.
    Akiyama Y, Houkin K, Nozaki K, Hashimoto N (2010) Practical decision-making in the treatment of unruptured cerebral aneurysm in Japan: the U-CARE study. Cerebrovasc Dis 30:491–499PubMedCrossRefGoogle Scholar
  2. 2.
    Aoki T, Kataoka H, Ishibashi R, Nozaki K, Hashimoto N (2008) Simvastatin suppresses the progression of experimentally induced cerebral aneurysms in rats. Stroke 39:1276–1285PubMedCrossRefGoogle Scholar
  3. 3.
    Bruneau M, Rynkowski M, Smida-Rynkowska K, Brotchi J, De Witte O, Lubicz B (2011) Long-term follow-up survey reveals a high yield, up to 30 % of patients presenting newly detected aneurysms more than 10 years after ruptured intracranial aneurysms clipping. Neurosurg Rev 34(4):485–496PubMedCrossRefGoogle Scholar
  4. 4.
    Chyatte D, Bruno G, Desai S, Todor DR (1999) Inflammation and intracranial aneurysms. Neurosurgery 45:1137–1146, discussion 1146–1137PubMedCrossRefGoogle Scholar
  5. 5.
    David CA, Vishteh AG, Spetzler RF, Lemole M, Lawton MT, Partovi S (1999) Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg 91:396–401PubMedCrossRefGoogle Scholar
  6. 6.
    Edner G, Almqvist H (2007) The Stockholm 20-year follow-up of aneurysmal subarachnoid hemorrhage outcome. Neurosurgery 60:1017–1024, 1010.1227/1001.NEU.0000255458.0000207140.E0000255456PubMedCrossRefGoogle Scholar
  7. 7.
    Hadeishi H, Yasui N, Suzuki A (1991) Risks of surgical treatment for unruptured intracranial aneurysms. No Shinkei Geka 19:945–949PubMedGoogle Scholar
  8. 8.
    Hata J, Doi Y, Ninomiya T, Fukuhara M, Ikeda F, Mukai N, Hirakawa Y, Kitazono T, Kiyohara Y (2011) Combined effects of smoking and hypercholesterolemia on the risk of stroke and coronary heart disease in Japanese: the Hisayama study. Cerebrovasc Dis 31(5):477–484PubMedCrossRefGoogle Scholar
  9. 9.
    Heiskanen O, Poranen A (1987) Surgery of incidental intracranial aneurysms. Surg Neurol 28:432–436PubMedCrossRefGoogle Scholar
  10. 10.
    Juvela S, Poussa K, Porras M (2001) Factors affecting formation and growth of intracranial aneurysms: a long-term follow-up study. Stroke 32:485–491PubMedCrossRefGoogle Scholar
  11. 11.
    Morita A (2002) On-line outcome study of unruptured cerebral aneurysm in Japan (UCAS Japan). Rinsho Shinkeigaku 42:1188–1190PubMedGoogle Scholar
  12. 12.
    Morita A, Fujiwara S, Hashi K, Ohtsu H, Kirino T (2005) Risk of rupture associated with intact cerebral aneurysms in the Japanese population: a systematic review of the literature from Japan. J Neurosurg 102:601–606PubMedCrossRefGoogle Scholar
  13. 13.
    Morita A, Kimura T, Sora S (2009) Clinical standard of neurosurgical disorder (5): management of the unruptured intracranial aneurysms. No Shinkei Geka 37:399–411PubMedGoogle Scholar
  14. 14.
    Nieuwkamp DJ, Algra A, Blomqvist P, Adami J, Buskens E, Koffijberg H, Rinkel GJ (2011) Excess mortality and cardiovascular events in patients surviving subarachnoid hemorrhage: a nationwide study in Sweden. Stroke 42:902–907PubMedCrossRefGoogle Scholar
  15. 15.
    Pera J, Korostynski M, Krzyszkowski T, Czopek J, Slowik A, Dziedzic T, Piechota M, Stachura K, Moskala M, Przewlocki R, Szczudlik A (2010) Gene expression profiles in human ruptured and unruptured intracranial aneurysms: what is the role of inflammation? Stroke 41(2):224–231PubMedCrossRefGoogle Scholar
  16. 16.
    Raaymakers TW, Rinkel GJ, Limburg M, Algra A (1998) Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis. Stroke 29:1531–1538PubMedCrossRefGoogle Scholar
  17. 17.
    Suzuki K (2008) Stroke register in Akita: incidence and the burden of diseases. Nihon Ronen Igakkai Zasshi 45:169–171PubMedCrossRefGoogle Scholar
  18. 18.
    Suzuki K (2009) Calculation of stroke events in Japan from 2005 to 2055. Sougou Rinshou 58:194–198Google Scholar
  19. 19.
    Tsutsumi K, Ueki K, Morita A, Usui M, Kirino T (2001) Risk of aneurysm recurrence in patients with clipped cerebral aneurysms: results of long-term follow-up angiography. Stroke 32:1191–1194PubMedCrossRefGoogle Scholar
  20. 20.
    Tsutsumi K, Ueki K, Usui M, Kwak S, Kirino T (1998) Risk of recurrent subarachnoid hemorrhage after complete obliteration of cerebral aneurysms. Stroke 29:2511–2513PubMedCrossRefGoogle Scholar
  21. 21.
    Tsutsumi K, Ueki K, Usui M, Kwak S, Kirino T (1999) Risk of subarachnoid hemorrhage after surgical treatment of unruptured cerebral aneurysms. Stroke 30:1181–1184PubMedCrossRefGoogle Scholar
  22. 22.
    van der Schaaf IC, Velthuis BK, Wermer MJH, Majoie C, Witkamp T, de Kort G, Freling NJ, Rinkel GJE, on behalf of the ASG (2005) New detected aneurysms on follow-up screening in patients with previously clipped intracranial aneurysms: comparison with DSA or CTA at the time of SAH. Stroke 36:1753–1758PubMedCrossRefGoogle Scholar
  23. 23.
    Wermer MJH, Greebe P, Algra A, Rinkel GJE (2005) Incidence of recurrent subarachnoid hemorrhage after clipping for ruptured intracranial aneurysms. Stroke 36:2394–2399PubMedCrossRefGoogle Scholar
  24. 24.
    Wermer MJH, van der Schaaf IC, Velthuis BK, Algra A, Buskens E, Rinkel GJE (2005) Follow-up screening after subarachnoid hemorrhage: frequency and determinants of new aneurysms and enlargement of existing aneurysms. Brain 128:2421–2429PubMedCrossRefGoogle Scholar
  25. 25.
    Wiebers DO, Piepgras DG, Brown RD Jr, Meissner I, Torner J, Kassell NF, Whisnant JP, Huston J 3rd, Nichols DA (2002) Unruptured aneurysms. J Neurosurg 96:50–51, discussion 58–60PubMedCrossRefGoogle Scholar
  26. 26.
    Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O’Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110PubMedCrossRefGoogle Scholar
  27. 27.
    Yonekura M (2004) Small unruptured aneurysm verification (SUAVe Study, Japan)–interim report. Neurol Med Chir (Tokyo) 44:213–214CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Masaaki Hokari
    • 1
  • Satoshi Kuroda
    • 1
  • Naoki Nakayama
    • 1
  • Kiyohiro Houkin
    • 1
  • Tatsuya Ishikawa
    • 2
  • Hiroyasu Kamiyama
    • 3
  1. 1.Department of NeurosurgeryHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.Department of Surgical NeurologyResearch Institute for Brain and Blood Vessels-AkitaAkitaJapan
  3. 3.Department of NeurosurgeryAsahikawa Red Cross HospitalAsahikawaJapan

Personalised recommendations