Kosin Med J.  2013 Jun;28(1):19-26. 10.7180/kmj.2013.28.1.19.

Endovascular or Microsurgical Treatment of Intracranial Aneurysms: Single Center Analysis

• Kim JW
• Seung WB
• Park YS

• KMID: 2308507
• DOI: http://doi.org/10.7180/kmj.2013.28.1.19

Abstract

OBJECTIVES
The objective of this study was to assess effectiveness and outcomes of endovascular versus microsurgical treatment for intracranial aneurysms in single hospital.
METHODS
This was a retrospective study, using data collected during 4 year (between 2008 and 2011) from single hospital(Kosin University Gospel Hospital). A total of 274 treated, intracranial aneurysm cases were evaluated. The measurements used were effectiveness as measured by hospital discharge outcomes: 1) mortality (in-hospital death), 2) clinical outcomes(modified Ranking Scale: mRS).
RESULTS
Among total of 274 cases, unruptured intracranial aneurysm cases were 132 cases and ruptured cases were 142 cases. Among unruptured 132 cases, 65 cases were treated by microsurgical treatment and 67 cases were treated by endovascular treatment. Among ruptured 142 cases, 61 cases were treated by microsurgical treatment and 81 cases were treated by endovascular treatment. In unruptured cases, there was not any fatal complication and same adverse outcomes (3% versus 3%). In ruptured case, in regards of treatment modality (i.e., endovascular versus microsurgical treatment), each clinical outcomes were as followings; good clinical outcome was 53.1% (43/81) versus 41.0% (25/61), moderate clinical outcome was 13.6% (1/81) versus 9.8% (6/61), severe clinical outcome was 18.5% (15/81) versus 22.9% (29/142) and fatal outcome was 14.8 (12/81) versus 26.2% (16/61).
CONCLUSIONS
This analysis of single hospital data indicates that endovascular therapy is associated with significantly less morbidity, less mortality, compared with conventional microsurgical treatment for all intracranial aneurysms. Endovascular therapy, as a treatment alternative to microsurgical clipping, should be offered as a viable therapeutic option for all patients considering treatment of an intracranial aneurysm.

Keyword

Endovascular; Intracranial aneurysm; Microsurgical

MeSH Terms

Fatal Outcome
Humans
Intracranial Aneurysm
Retrospective Studies

Reference

1.Magnetic Resonance Angiography in Relatives of Patients with Subarachnoid Hemorrhage Study Group. Risks and benefits of screening for intracranial aneurysms in first-degree relatives of patients with sporadic subarachnoid hemorrhage. N Engl J Med. 1999. 341:1344–50.

2.Bardach NS., Olson SJ., Elkins JS., Smith WS., Lawton MT., Johnston SC. Regionalization of treatment for subarachnoid hemorrhage. A cost-utility analysis. Circulation. 2004. 109:2207–12.

3.Barker FG II., Amin-Hanjani S., Butler WE., Hoh BL., Rabinov JD., Pryor JC, et al. Age-dependent differences in short-term outcome after surgical or endovascular treatment of unruptured intracranial aneurysms in the United States, 1996– 2000. Neurosurgery. 2004. 54:18–28. discussion 28-30.

4.Andaluz N., Zuccarello M. Recent trends in the treatment of cerebral aneurysms: analysis of a nationwide inpatient database. J Neurosurg. 2008. 108:1163–9.

5.Brilstra EH., Rinkel GJ., van der Graaf Y., Sluzewski M., Groen RJ., Lo RT, et al. Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils. A prospective, observational study. Cerebrovasc Dis. 2004. 17:44–52.

6.Flett LM., Chandler CS., Giddings D., Gholkar A. Aneurysmal subarachnoid hemorrhage: management strategies and clinical outcomes in a regional neuroscience center. AJNR Am J Neuroradiol. 2005. 26:367–72.

7.Halkes PH., Wermer MJ., Rinkel GJ., Buskens E. Direct costs of surgical clipping and endovascular coiling of unruptured intracranial aneurysms. Cerebrovasc Dis. 2006. 22:40–5.

8.Bederson JB., Awad IA., Wiebers DO., Piepgras D., Haley EC Jr., Brott T, et al. Recommendations for the management of patients with unruptured intracranial aneurysms: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Circulation. 2000. 102:2300–8.

9.Johnston SC., Higashida RT., Barrow DL., Caplan LR., Dion JE., Hademenos G, et al. Recommendations for the endovascular treatment of intracranial aneurysms: a statement for healthcare professionals from the Committee on Cerebrovascular Imaging of the American Heart Association Council on Cardiovascular Radiology. Stroke. 2002. 33:2536–44.

10.Greenberg MS. SAH and aneurysms. In: Greenberg MS, ed. Handbook of neurosurgery. 6th ed. New York: Thieme Medical 2006. p. 781–834.

11.King JT Jr., Berlin JA., Flamm ES. Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: a meta-analysis. J Neurosurg. 1994. 81:837–42.

12.Johnston SC., Selvin S., Gress DR. The burden, trends, and demographics of mortality from subarachnoid hemorrhage. Neurology. 1998. 50:1413–8.

13.Raaymakers TW., Rinkel GJ., Limburg M., Algra A. Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis. Stroke. 1998. 29:1531–8.

14.Wiebers DO., Whisnant JP., Huston J 3rd., Meissner I., Brown RD Jr., Piepgras DG, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003. 362:103–10.

15.Raymond J., Guilbert F., Weill A., Georganos SA., Juravsky L., Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003. 34:1398–403.

16.Thornton J., Debrun GM., Aletich VA., Bashir Q., Charbel FT., Ausman J. Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery. 2002. 50:239–49. discussion 249-50.

17.Slob MJ., Sluzewski M., van Rooij WJ., Roks G., Rinkel GJ. Additional coiling of previously coiled cerebral aneurysms: clinical and angiographic results. AJNR Am J Neuroradiol. 2004. 25:1373–6.

18.Johnston SC., Wilson CB., Halbach VV., Higashida RT., Dowd CF., McDermott MW, et al. Endovascular and surgical treatment of unruptured cerebral aneurysms: comparison of risks. Ann Neurol. 2000. 48:11–9.

19.Johnston SC., Zhao S., Dudley RA., Berman MF., Gress DR. Treatment of unruptured cerebral aneurysms in California. Stroke. 2001. 32:597–605.

20.Johnston SC., Dudley RA., Gress DR., Ono L. Surgical and endovascular treatment of unruptured cerebral aneurysms at university hospitals. Neurology. 1999. 52:1799–805.

21.Molyneux A., Kerr R., Stratton I., Sandercock P., Clarke M., Shrimpton J, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002. 360:1267–74.

22.Molyneux AJ., Kerr RS., Yu LM., Clarke M., Sneade M., Yarnold JA, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005. 366:809–17.

23.Derdeyn CP., Barr JD., Berenstein A., Connors JJ., Dion JE., Duckwiler GR, et al. The International Subarachnoid Aneurysm Trial (ISAT): a position statement from the Executive Committee of the American Society of Interventional and Therapeutic Neuroradiology and the American Society of Neuroradiology. AJNR Am J Neuroradiol. 2003. 24:1404–8.

24.Harbaugh RE., Heros RC., Hadley MN. Position statement on the International Subarachnoid Aneurysm Trial(ISAT). AANS Bulletin. 2002. 11:20–1.

25.The International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention. N Engl J Med. 1998. 339:1725–33.