Evaluation of Microsurgery for Managing Giant or Complex Cerebral Aneurysms: A Retrospective Study.

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Evaluation of Microsurgery for Managing Giant or Complex Cerebral Aneurysms: A Retrospective Study.

World Neurosurg. 2018 Apr 10;:

Authors: Ota N, Matsukawa H, Noda K, Sato H, Hatano Y, Hashimoto A, Miyazaki T, Kondo T, Kinoshita Y, Saito N, Kamiyama H, Tokuda S, Kamada K, Tanikawa R

Abstract
OBJECTS: Surgical or endovascular treatment for giant or complex aneurysms is challenging. To evaluate clinical outcomes and factors affecting the prognosis of giant or complex aneurysms, and to better establish the role of microsurgery in the management strategy.
METHODS: One hundred fifty-nine patients with surgically treated complex aneurysms were included. Thirty-two (20.1%) patients had giant aneurysms (≥25 mm); 57 (35.8%) had large aneurysms (≥15 mm). Poor outcome was defined as modified Rankin scale scores 3-6.
RESULTS: The mean aneurysm size was 17.0 mm (range, 1.6-47.5 mm). One hundred sixteen aneurysms (80.0%) were in the anterior circulation; 43 (27.0%) were in the posterior circulation. One hundred thirty-eight (86.8%) aneurysms were completely occluded without residual aneurysms. Nineteen (11.9%) had minor aneurysm remnants; 2 (1.3%) had incomplete occlusion. Two patients (1.3%) with giant basilar artery (BA) trunk aneurysms experienced rupture of the treated aneurysm and died. Bypass surgery was combined with microsurgery in 148 patients (93.1%). Perforating artery infarction was observed postoperatively in 42 (26.4%) patients, and poor outcome was observed in 29 (18.2%). Male sex (p=0.016; adjusted odds ratio [OR]: 4.524 [1.949-10.500]), perforating artery infarction (p<0.001; adjusted OR: 13.625 [5.329-34.837]), and BA aneurysm location (p=0.003; adjusted OR: 56.333 [6.830-464.657]) were significantly related to poor outcome. The aneurysm size (p=0.017; adjusted OR: 1.064 [1.021-1.107]), C1 aneurysm location (p=0.042; adjusted OR: 2.591 [0.986-6.811]), and BA aneurysm location (p=0.033; adjusted OR: 12.956 [3.197-52.505]) were significantly related to perforating artery infarction.
CONCLUSION: Microsurgery with bypass is effective for many different complex aneurysms, except BA aneurysms.

PMID: 29653272 [PubMed - as supplied by publisher]

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