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Impact of aneurysm shape on morbidity after clipping of unruptured intracranial aneurysms

  • Original Article -Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

Complex aneurysm shape is a predominant risk factor for aneurysm rupture but its impact on clinical outcome after clipping remains unclear. The objective of the present study was to compare complications and morbidity after clipping of unruptured single-sac aneurysms (SSAs) and aneurysms with multiple sacs (MSAs).

Methods

A retrospective, single-center study was conducted for patients that were treated between 2010 and 2018. We analyzed surgical parameters, treatment-related complications, and morbidity, defined as any increase in the modified Rankin scale at 3-month follow-up.

Results

We identified 101 patients (mean age: 52.9 ± 10.5 years) that underwent clipping for 57 SSAs and 44 MSAs. The two groups were comparable regarding aneurysm size and neck width. Clipping of MSAs was associated with a longer operation time (p = 0.008) and increased use of intraoperative indocyanine green (p = 0.016) than SSAs. Complications occurred more often in the MSA group (29.5%) than in the SSA group (14.0%; p = 0.057). Morbidity was significantly higher in the MSA group (20.5%) than in the SSA group (3.5%, p = 0.009). In the univariate analysis, the odds of morbidity were 7.1 times greater for MSAs than for SSAs (95% CI 1.4–34.7).

Conclusions

Morbidity after microsurgical clipping is significantly increased in MSAs as compared to SSAs. This may be attributed to a more difficult clip placement with stronger manipulation of the aneurysm dome and the surrounding brain tissue.

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Authors and Affiliations

  1. Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany

    Lukas Goertz, Christina Hamisch, Niklas von Spreckelsen, Dagmar Ludyga, Marco Timmer, Pantelis Stavrinou, Roland Goldbrunner, Gerrit Brinker & Boris Krischek

  2. Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan

    Hidetoshi Kasuya

  3. Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany

    Christoph Kabbasch

Authors
  1. Lukas Goertz
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  2. Hidetoshi Kasuya
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  3. Christina Hamisch
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  4. Christoph Kabbasch
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  5. Niklas von Spreckelsen
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  6. Dagmar Ludyga
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  7. Marco Timmer
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  8. Pantelis Stavrinou
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  9. Roland Goldbrunner
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  10. Gerrit Brinker
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  11. Boris Krischek
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Corresponding author

Correspondence to Lukas Goertz.

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Conflict of interest

The authors declare that they have no 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.

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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.

For this type of study, formal consent is not required.

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

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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Goertz, L., Kasuya, H., Hamisch, C. et al. Impact of aneurysm shape on morbidity after clipping of unruptured intracranial aneurysms. Acta Neurochir 160, 2169–2176 (2018). https://doi.org/10.1007/s00701-018-3675-9

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  • DOI: https://doi.org/10.1007/s00701-018-3675-9

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