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Surgical clipping of very small unruptured intracranial aneurysms: a multicenter international study.

Bruneau, Michaël
Amin-Hanjani, Sepideh
Koroknay-Pal, Päivi
Jahromi, Behnam Rezai
Lehto, Hanna
Kivisaari, Riku
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Published in Neurosurgery. 2016, vol. 78, no. 1, p. 47-52
Abstract BACKGROUND: Treatment of very small unruptured intracranial aneurysms (VSUIAs, defined as #3 mm) can be indicated in selected circumstances. The feasibility and outcomes of endovascular therapy for VSUIAs have been recently published; however, the efficacy and complication rate of surgical clipping has not been reported in any large series to date. OBJECTIVE: We conducted a multicenter study to examine surgical outcomes for VSUIAs. METHODS: All consecutive patients undergoing surgery for a VSUIA in 4 neurosurgical centers between October 2001 and December 2012 were retrospectively analyzed. RESULTS: In the study, 183 patients (128 women, mean age 51.3 years) were treated with 190 procedures for a total of 228 aneurysms. Most were anterior circulation aneurysms (n = 215). The majority were directly clipped (n = 222, 97.4%), with coagulation or wrapping in the remainder. After 1 reoperation for incomplete clipping, postoperative imaging of 225 aneurysms confirmed complete occlusion in 221 (98.2%), 1 neck remnant (0.44%), and 3 partial occlusions (1.3%). Mortality was 0%. Early postoperative neurological deficit developed in 12 patients (6.6%); posterior circulation location was a significant risk factor for early neurological deficit (P , .001). Middle cerebral artery aneurysms had the lowest rate of postoperative deficits at 1.5% (P = .023). After the initial 30-day perioperative period, all deficits related to treatment of posterior circulation aneurysms recovered; overall neurological morbidity decreased to 2.7% with no mortality. CONCLUSION: VSUIA clipping is highly effective and is associated with a low morbidity rate. For VSUIAs selected for treatment, our data support surgical clipping as the modality of choice.
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Research group Groupe Schaller Karl Lothard (neurochirurgie) (851)
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BRUNEAU, Michaël et al. Surgical clipping of very small unruptured intracranial aneurysms: a multicenter international study. In: Neurosurgery, 2016, vol. 78, n° 1, p. 47-52. https://archive-ouverte.unige.ch/unige:79318

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Deposited on : 2016-01-14

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