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Association of preoperative aneurysmal wall enhancement with relief of chronic headache after surgical clipping of unruptured intracranial aneurysms

  • Magnetic Resonance
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Abstract

Objective

To investigate the association between chronic headache outcome and aneurysmal wall enhancement (AWE) on high-resolution vessel wall imaging (HR-VWI) in patients with unruptured intracranial aneurysms (UIAs) who underwent microsurgical clipping.

Methods

Two hundred seventy-four UIA patients were retrospectively analyzed. Patients were grouped according to presence of AWE. AWE was subclassified as focal or uniform. Clinical and imaging data were recorded. Headache was evaluated using the 10-point numerical rating scale and Headache Impact Test-6 before and 6 months after surgery.

Results

The proportions of patients reporting chronic headache in the no AWE, focal wall enhancement (FWE), and uniform wall enhancement (UWE) groups were 5.7%, 24.8%, and 41.8%, respectively. All patients in the UWE group who reported headache before surgery experienced headache improvement after surgery. Decrease in headache severity was greater in the UWE group than in the FWE group. Multivariate binary logistic regression showed that FWE (odds ratio (OR) 0.490; 95% confidence interval (CI), 0.262–0.917; p = 0.026) and small intraluminal thrombus (OR 0.336; 95% CI, 0.142–0.795; p = 0.013) were independent factors protective against preoperative headache. FWE (OR 0.377; 95% CI, 0.195–0.728; p = 0.004) and small intraluminal thrombus (OR 0.235; 95% CI, 0.088–0.630; p = 0.004) were independent predictors of no headache relief after surgery.

Conclusions

AWE on HR-VWI is associated with relief of chronic headache after surgical clipping in patients with UIAs. Incidence of chronic headache was highest in patients exhibiting UWE. These patients also experienced the greatest improvement in headache after surgical clipping.

Clinical relevance statement

This study revealed that high-resolution vessel wall imaging can demonstrate aneurysmal wall plaque and intraluminal thrombus, which may be prognostic imaging markers for chronic headache in patients with unruptured intracranial aneurysms.

Key Points

• Aneurysmal wall enhancement may be associated with chronic headache.

• Incidence of chronic headache was highest in patients with aneurysms exhibiting uniform wall enhancement.

• Patients with aneurysms exhibiting uniform wall enhancement experienced the greatest improvement in headache after clipping.

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Abbreviations

AWE:

Aneurysmal wall enhancement

CI:

Confidence interval

CNS:

Central nervous system

FWE:

Focal wall enhancement

HAMA:

Hamilton Anxiety Rating Scale

HIT-6:

Headache Impact Test-6

HR-VWI:

High-resolution vessel wall magnetic resonance imaging

mRS:

Modified Rankin scale

NRS:

Numerical rating scale

NSAIDs:

Non-steroidal anti-inflammatory drugs

OR:

Odds ratio

SAH:

Subarachnoid hemorrhage

UIAs:

Unruptured intracranial aneurysms

UWE:

Uniform wall enhancement

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Acknowledgements

We thank Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the language of this manuscript.

Funding

This study was supported by the National Natural Science Foundation of China (No. 82171311, No. 81801148), Shanghai Excellent Academic Leader Program (No. 21XD1400600), Shanghai Science and Technology Commission Project (No. 23ZR1408700), Clinical Research Plan of SHDC (No. SHDC2020CR2034B, No. SHDC2020CR4033) and ZJ Lab, and CAMS Innovation Fund for Medical Sciences (CIFMS, 2019-I2M-5–008).

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Correspondence to Yu Ma, Ying Mao or Wei Zhu.

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Guarantor

The scientific guarantor of this publication is “Wei Zhu,” and the institution is “Department of Neurosurgery, Huashan Hospital, Fudan University.”

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

“Jianfeng Luo” kindly provided statistical advice for this manuscript.

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Written informed consent was obtained from all subjects in this study.

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Institutional Review Board approval was obtained (IRB 2017-D386).

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None.

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  • Performed at one institution

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Quan, K., Hu, L., Zhang, S. et al. Association of preoperative aneurysmal wall enhancement with relief of chronic headache after surgical clipping of unruptured intracranial aneurysms. Eur Radiol 34, 3009–3018 (2024). https://doi.org/10.1007/s00330-023-10303-0

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