Purpose
For last three decades the treatment of intracranial aneurysms has become as much radiological as neurosurgical problem.
However there is still no agreement which of these approaches is more beneficial for patients.
The initial (based on the one-year follow-up data) outcomes of the International Subarachnoid Aneurysm Trial (ISAT) published in 2002 [1] implied that endovascular coiling comparing to neurosurgical clipping seems to be a better therapeutic option for a ruptured intracranial aneurysms due to an absolute dependency or death risk reduction.
Findings of this study...
Methods and Materials
We carried out a retrospective study.
Between year 2008 and 2012,
68 patients (average age 53.17 years,
SD=10.74) were diagnosed with 73 MCAAs,
and subsequently qualified for the treatment (clipping or coiling).
The choice of the preferred strategy was made by a interdisciplinary team of neurosurgeons and interventional neuroradiologists.
In cases of patients who underwent more than one embolization of the same aneurysm,
only the first procedure was included in our study and submitted for further analysis.
Also patients who had the first procedure before...
Results
The patient characteristics are presented in Table 1.
The mean age of all patients was 53.17 years (range 21-73) and was similar in neurosurgical and radiological group (53.4 vs.
52.9; p=0.86). A sex distribution in the examined populations was comparable as well (p=0.51).
The majority of patients were women (77.9%).
The data concerning clinical condition of patients following subarachnoid hemorrhage is outlined in Table 2.
At the hospital admission the Hunt and Hess scale and Fisher scale grades were 1 or 2 in 61% and...
Conclusion
Based on our material we have found that the clinical and radiological effects of embolization and clipping of the MCAAs are similar.
For good outcomes in the MCAAs treatment the qualification strategy (coiling/clipping) has to be individualized depending on aneurysm morphology – significant differences between radiological and neurosurgical group noticed in dome-to-neck ratio.
Very good effects of endovascular treatment of complex MCA aneurysms were noticed in our population,
probably due to common use of balloon or stent assisted coil embolization in these cases.
Although clinical...
References
[1] Molyneux A,
Kerr R,
Stratton I,
Sandercock P,
Clarke M,
Shrimpton J,
Holman R; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group.
International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial.
Lancet.
2002 Oct 26;360(9342):1267-74.
[2] Molyneux AJ,
Kerr RS,
Birks J,
Ramzi N,
Yarnold J,
Sneade M,
Rischmiller J; ISAT Collaborators.
Risk of recurrent subarachnoid haemorrhage,
death,
or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in...
Personal Information
Bartosz Kapustka,
Medical Student,
Medical University of Silesia,
Katowice,
Poland;
kapustka.bartosz@gmail,com
Konrad Kubicki MD,
Ministry of Interior Hospital in Katowice,Poland;
[email protected]
Adrian Matlak MD,District Hospital in Katowice,
Poland;
[email protected]
Ryszard Sordyl MD,
Medical University of Silesia,
Katowice,
Poland;
[email protected]
Stanisław Kwiek PhD,
Dept.
of Neurosurgery,
Medical University of Silesia,Katowice,
Poland
Piotr Bażowski MD,
PhD,
Prof.,
Dept.
of Neurosurgery,
Medical University of Silesia,
Katowice,
Poland
Daniel Knap MD,
PhD,
Dept.
of Radiology & Nuclear Medicine,
Medical University of Silesia,
Katowice,
Poland;
[email protected]
Jan Baron MD,
PhD,...