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Cranial nerve deficits in giant cavernous carotid aneurysms and their relation to aneurysm morphology and location

  • Original Article - Vascular
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Abstract

Background

Giant cavernous carotid aneurysms (GCCAs) usually exert substantial mass effect on adjacent intracavernous cranial nerves. Since predictors of cranial nerve deficits (CNDs) in patients with GCCA are unknown, we designed a study to identify associations between CND and GCCA morphology and the location of mass effect.

Methods

This study was based on data from the prospective clinical and imaging databases of the Giant Intracranial Aneurysm Registry. We used magnetic resonance imaging and digital subtraction angiography to examine GCCA volume, presence of partial thrombosis (PT), GCCA origins, and the location of mass effect. We also documented whether CND was present.

Results

We included 36 GCCA in 34 patients, which had been entered into the registry by eight participating centers between January 2009 and March 2016. The prevalence of CND was 69.4%, with one CND in 41.7% and more than one in 27.5%. The prevalence of PT was 33.3%. The aneurysm origin was most frequently located at the anterior genu (52.8%). The prevalence of CND did not differ between aneurysm origins (p = 0.29). Intracavernous mass effect was lateral in 58.3%, mixed medial/lateral in 27.8%, and purely medial in 13.9%. CND occurred significantly more often in GCCA with lateral (81.0%) or mixed medial/lateral (70.0%) mass effect than in GCCA with medial mass effect (20.0%; p = 0.03). After adjusting our data for the effects of the location of mass effect, we found no association between the prevalence of CND and aneurysm volume (odds ratio (OR) 1.30 (0.98–1.71); p = 0.07), the occurrence of PT (OR 0.64 (0.07–5.73); p = 0.69), or patient age (OR 1.02 (95% CI 0.95–1.09); p = 0.59).

Conclusions

Distinguishing between medial versus lateral location of mass effect may be more helpful than measuring aneurysm volumes or examining aneurysm thrombosis in understanding why some patients with GCCA present with CND while others do not.

Clinical trial registration no.

NCT02066493 (clinicaltrials.gov)

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Acknowledgements

The authors would like to thank all members of the Giant Intracranial Aneurysm Group.

Funding

The Giant Intracranial Aneurysm Registry is funded by the Center for Stroke Research-Berlin (Grant No. CS-2009-12) to JD, the coordinating officer of the registry. The sponsor had no role in the design or conduct of this research.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Bezirkskrankenhaus Günzburg, University of Ulm, Günzburg, Germany

    G. Durner & M. T. Pedro

  2. Department of Neuroradiology, Metropolitan Hospital Niguarda, Milan, Italy

    M. Piano & E. Boccardi

  3. Department of Neurosurgery, Charité-Universitaetsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany

    P. Lenga, P. Vajkoczy & Julius Dengler

  4. Department of Neurosurgery, Georg-August-University Goettingen, Goettingen, Germany

    D. Mielke

  5. Department of Neurosurgery, BG-Clinic Bergmannstrost, Halle, Germany

    C. Hohaus

  6. Department of Neurosurgery, University of Greifswald, Greifswald, Germany

    S. Guhl

  7. Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland

    N. Maldaner & J. K. Burkhardt

  8. Department of Neurosurgery, Technical University of Munich, Munich, Germany

    J. Lehmberg

  9. Department of Neuroradiology, Clinic Hirslanden, Zurich, Switzerland

    D. Rufenacht

  10. Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland

    P. Bijlenga

  11. Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany

    N. Etminan & D. Hänggi

  12. Department of Neurosurgery, Hannover Medical School, Hannover, Germany

    J. K. Krauss

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  1. G. Durner
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  2. M. Piano
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  8. J. K. Burkhardt
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Consortia

on behalf of the Giant Intracranial Aneurysm Study Group

Corresponding author

Correspondence to Julius Dengler.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Dr. Nima Etminan is a member of Medical monitor and steering committee NEWTON 2 and received Research grant PROTECT-U, which are unrelated to the present study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

AppendixMembers of the Giant Intracranial Aneurysm Study Group:

AppendixMembers of the Giant Intracranial Aneurysm Study Group:

P. Vajkoczy, P. Lenga, J. Dengler: Department of Neurosurgery, Charité – Universitaetsmedizin Berlin, Germany; M. Endres: Department of Neurology, Charité – Universitaetsmedizin Berlin, Germany; T. Liebig, G. Bohner, E. Wiener, H.C. Bauknecht: Department of Neuroradiology, Charité – Universitaetsmedizin Berlin, Germany; P.U. Heuschmann, K. Uttinger, U. Malzahn: Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany; J.-H. Klingler, S.Gläsker, J. Zentner, V. Van Velthoven: Department of Neurosurgery, University Hospital Freiburg, Germany; S. Guhl, H.W.S. Schroeder: Department of Neurosurgery, University of Greifswald, Germany; M. Strowitzki: Department of Neurosurgery, Trauma Center Murnau, Murnau, Germany; S. Eicker, B. Turowski: Department of Neurosurgery, University of Düsseldorf, Germany; N. Etminan, D. Haenggi: Department of Neurosurgery, University Hospital Mannheim, Germany; K.M. Schebesch, A. Brawanski: Department of Neurosurgery, University of Regensburg, Germany; K. Wrede, U. Sure: Department of Neurosurgery, University of Essen, Germany; N.O. Schmidt, J. Regelsberger, M. Westphal: Department of Neurosurgery, University Medical Center, Hamburg Eppendorf, Germany; D. Mielke, V. Rohde: Department of Neurosurgery, Georg-August-University Goettingen, Germany; H. Hosch, D. Moskopp: Department of Neurosurgery Vivantes-Klinikum im Friedrichshain, Berlin, Germany; C. Hohaus, H.J. Meisel: Department of Neurosurgery, BG-Clinic Bergmannstrost, Halle, Germany; M. Wostrack, B. Meyer, J. Lehmberg: Department of Neurosurgery, Technical University of Munich, Germany; O. Ganslandt, C. Musahl, N. Hopf: Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany; A. Graewe, U. Meier: Department of Neurosurgery, Unfallkrankenhaus Berlin, Germany; B. Hong, M. Nakamura, J. Krauss: Department of Neurosurgery, Hannover Medical School, Hannover, Germany; A. Grote, M. Simon, J. Schramm, E. Güresir, H. Vatter: Department of Neurosurgery, University Hospital Bonn, Bonn, Germany; A. Kursumovic, S.A. Rath: Department of Neurosurgery and Interventional Neuroradiology, Donau-Isar-Klinikum, Deggendorf, Germany; S. Marbacher, J. Fandino, M. Diepers: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland; P. Familiari, A. Raco: Department of Neurosurgery, University of Rome ‘Sapienza’, Rome, Italy; P. Bijlenga, K. Schaller: Service de Neurochirurgie, Faculté de Médecine de Genève and Hôpitaux Universitaire de Genève, Switzerland; A. Gruber, W.T. Wang, E. Knosp: Department of Neurosurgery, Medical University Vienna, Vienna, Austria; K.T. Hoffmann, E. Boxhammer: Department of Neuroradiology, University of Leipzig, Leipzig, Germany; D.A. Rüfenacht, I. Wanke: Department of Neuroradiology, Klinik Hirslanden, Zurich, Switzerland; E. Boccardi, M. Piano: Department of Neuroradiology, Ospedale Niguarda Ca′ Granda, Milano, Italy; M. Niemelä, V. Nurminen, M. Lehecka, J. Hernesniemi: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; J.K. Burkhardt, O. Bozinov, N. Maldaner, L. Regli: Department of Neurosurgery, University Hospital of Zurich, Switzerland; O.D. Shekhtman, S.S. Eliava: Burdenko Neurosurgical Institute, Russian Academy of Medical Sciences, Moscow, Russia; N. Kato, K. Irie, K. Nishimura, S. Kaku, H. Arakawa, I. Yuki, T. Ishibashi, Y. Murayama: Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan; I. Fiss, T. Kombos: Department of Spine Surgery and Neurosurgery, Helios Klinikum Hildesheim, Hildesheim, Germany; M.T. Pedro, R. König, R. Wirtz, G. Durner, V. Hagel: Department of Neurosurgery, University Hospital of Ulm, Germany; J. Helthuis, A. van der Zwan, T. van Doormaal: Department of Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands; C. Cognard, M. Gawlitza, A. Guenego: Department of Neuroradiology, Toulouse University Hospital, Toulouse, France; J. Walter, R. Kalff: Department of Neurosurgery, University Hospital Jena, Germany; J. Fiedler: Department of Neurosurgery, Budweis Hospital, Czech Republic; I. Linfante, D. Guilherme, KA. Starosciak: Interventional Neuroradiology and Endovascular Neurosurgery at Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, Miami, USA; MS. Miran, MFK. Suri: Department of Neurology University of Minnesota; Minnesota, USA.

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Durner, G., Piano, M., Lenga, P. et al. Cranial nerve deficits in giant cavernous carotid aneurysms and their relation to aneurysm morphology and location. Acta Neurochir 160, 1653–1660 (2018). https://doi.org/10.1007/s00701-018-3580-2

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  • DOI: https://doi.org/10.1007/s00701-018-3580-2

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