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Goertz L, Radomi A, Forbrig R, Pflaeging M, Kabbasch C, Liebig T. Endovascular treatment of aneurysm remnants with the Contour Neurovascular System after previous treatment. Interv Neuroradiol 2024:15910199241264871. [PMID: 39091055 DOI: 10.1177/15910199241264871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE The Contour Neurovascular System (CNS) is a novel intrasaccular flow disrupting device with a semi-3D cup-like shape for the treatment of intracranial aneurysms. This study investigates the potential and limitations of the CNS for embolization of aneurysm remnants after previous treatment. METHODS Ten cases of aneurysm recurrence treatment with the CNS were analyzed from a single-center database. Technical success, procedural aspects, complications, and angiographic results were evaluated. RESULTS The aneurysms (median width: 5.3 mm, median neck width: 3.8 mm) were located in the anterior communicating artery (4), basilar tip (3), internal carotid artery (1), middle cerebral artery (1), and superior cerebellar artery (1). The aneurysms were initially treated endovascularly (9) and by clipping (1). Retreatment failed in one case where the smallest available CNS proved to be too small and had to be removed. Adjunctive coiling was performed in two large remnants of partially thrombosed basilar tip aneurysms. There were no procedural complications or morbidity. At a median follow-up of nine months, 4/8 (50%) aneurysms were completely occluded, 2/8 (25%) had neck remnants, and 2/8 (25%) had aneurysm remnants. The two aneurysm remnants were retreated with coiling and stent-assisted coiling, respectively. CONCLUSIONS CNS treatment of aneurysm remnants may be feasible, especially for shallow, wide-necked aneurysm geometries. Further studies are needed to identify aneurysm subsets that benefit from CNS retreatment and to define mid- and long-term occlusion rates.
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Affiliation(s)
- Lukas Goertz
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany
| | - Alexandra Radomi
- Institute of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Muriel Pflaeging
- Institute of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Christoph Kabbasch
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
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2
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The mechanism and therapy of aortic aneurysms. Signal Transduct Target Ther 2023; 8:55. [PMID: 36737432 PMCID: PMC9898314 DOI: 10.1038/s41392-023-01325-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/15/2022] [Accepted: 01/14/2023] [Indexed: 02/05/2023] Open
Abstract
Aortic aneurysm is a chronic aortic disease affected by many factors. Although it is generally asymptomatic, it poses a significant threat to human life due to a high risk of rupture. Because of its strong concealment, it is difficult to diagnose the disease in the early stage. At present, there are no effective drugs for the treatment of aneurysms. Surgical intervention and endovascular treatment are the only therapies. Although current studies have discovered that inflammatory responses as well as the production and activation of various proteases promote aortic aneurysm, the specific mechanisms remain unclear. Researchers are further exploring the pathogenesis of aneurysms to find new targets for diagnosis and treatment. To better understand aortic aneurysm, this review elaborates on the discovery history of aortic aneurysm, main classification and clinical manifestations, related molecular mechanisms, clinical cohort studies and animal models, with the ultimate goal of providing insights into the treatment of this devastating disease. The underlying problem with aneurysm disease is weakening of the aortic wall, leading to progressive dilation. If not treated in time, the aortic aneurysm eventually ruptures. An aortic aneurysm is a local enlargement of an artery caused by a weakening of the aortic wall. The disease is usually asymptomatic but leads to high mortality due to the risk of artery rupture.
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Chen SJ, Chen LD. Intraoperative blood flow monitor for aneurysm clipping: A comparison between Flowmetry and Indocyanine Green videoangiography. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_237_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Xue T, Deng R, Gao B, Wang Z, Ma C, You W, Zhu Y, Chen Z, Wang Z. Intraoperative indocyanine green video angiography (ICG-VA) with FLOW 800 software in complex intracranial aneurysm surgery. Chin Neurosurg J 2021; 7:28. [PMID: 34059164 PMCID: PMC8168317 DOI: 10.1186/s41016-021-00247-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/20/2021] [Indexed: 11/11/2022] Open
Abstract
Background Indocyanine green video angiography (ICG–VA) is a safe and effective instrument to assess changes in cerebral blood flow during cerebrovascular surgery. After ICG-VA, FLOW 800 provides a color-coded map to directly observe the dynamic distribution of blood flow and to calculate semiquantitative blood flow parameters later. The purpose of our study is to assess whether FLOW 800 is useful for surgery of complex intracranial aneurysms and to provide reliable evidence for intraoperative decision-making. Methods We retrospectively reviewed patients with complex aneurysms that underwent microsurgical and intraoperative evaluation of ICG-VA and FLOW 800 color-coded maps from February 2019 to May 2020. FLOW 800 data were correlated with patient characteristics, clinical outcomes, and intraoperative decision-making. Results The study included 32 patients with 42 complex aneurysms. All patients underwent ICG-VA FLOW 800 data provided semiquantitative data regarding localization, flow status in major feeding arteries; color maps confirmed relative adequate flow in parent, branching, and bypass vessels. Conclusions FLOW 800 is a useful supplement to ICG-VA for intraoperative cerebral blood flow assessment. ICG-VA and FLOW 800 can help to determine the blood flow status of the parent artery after aneurysm clipping and the bypass vessels after aneurysm bypass surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s41016-021-00247-z.
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Affiliation(s)
- Tao Xue
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Ruming Deng
- Department of Neurosurgery, Bozhou People's Hospital, Bozhou, Anhui Province, China
| | - Bixi Gao
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Zilan Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Chao Ma
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Wanchun You
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Yun Zhu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Zhouqing Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
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Goertz L, Liebig T, Siebert E, Pennig L, Laukamp KR, Celik E, Timmer M, Brinker G, Schlamann M, Goldbrunner R, Dorn F, Krischek B, Kabbasch C. Woven Endobridge Embolization Versus Microsurgical Clipping for Unruptured Anterior Circulation Aneurysms: A Propensity Score Analysis. Neurosurgery 2021; 88:779-784. [PMID: 33372215 DOI: 10.1093/neuros/nyaa539] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Intrasaccular flow-disruption represents a new paradigm in endovascular treatment of wide-necked bifurcation aneurysms. OBJECTIVE To retrospectively compare Woven Endobridge (WEB) embolization with microsurgical clipping for unruptured anterior circulation aneurysms using propensity score adjustment. METHODS A total of 63 patients treated with WEB and 103 patients treated with clipping were compared based on the intention-to-treat principle. The primary outcome measures were immediate technical treatment success, major adverse events, and 6-mo complete aneurysm occlusion. RESULTS The technical success rates were 83% for WEB and 100% for clipping. Procedure-related complications occurred more often in the clipping group (13%) than the WEB group (6%, adjusted P < .01). However, the rates of major adverse events were comparable in both groups (WEB: 3%, clip: 4%, adjusted P = .53). At the 6-mo follow-up, favorable functional outcomes were achieved in 98% of the WEB embolization group and 99% of the clipping group (adjusted P = .19). Six-month complete aneurysm occlusion was obtained in 75% of the WEB group and 94% of the clipping group (adjusted P < .01). CONCLUSION Microsurgical clipping was associated with higher technical success and complete occlusion rates, whereas WEB had a lower complication rate. Favorable functional outcomes were achieved in ≥98% of both groups. The decision to use a specific treatment modality should be made on an individual basis and in accordance with the patient's preferences.
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Affiliation(s)
- Lukas Goertz
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, University Hospital of Berlin (Charité), Berlin, Germany
| | - Lenhard Pennig
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Kai Roman Laukamp
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Erkan Celik
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marco Timmer
- Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Gerrit Brinker
- Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Boris Krischek
- Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Department of Neurosurgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Christoph Kabbasch
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Zárate-Méndez AM, Ramos-Delgado JM, Lujan-Guerra JC, Rio-Olivares CD, Moreira-Ponce LE, Aceves-Chimal JL. Three-Dimensional Virtual Reality Simulation to Safe Planning Neurosurgical Procedure in Brain Aneurysms, Latin American Single-Center Experience: Advantages and Limitations. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1725233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Background The neurosurgical approach to clipping cerebral aneurysms has been a complex challenge for all neurosurgeon experts in cerebrovascular surgery. The three-dimensional computed tomography angiography (3D-CTA) allows identifying bone and vascular structures close to an aneurysm to simulate in virtual 3D images, the appropriate and safest approach to cerebral aneurysm clipping.
Objectives This study aims to share our experience using 3D simulation as a support to the safe planning for cerebrovascular disease surgery.
Materials and Methods We reviewed the surgical outcomes from a cerebrovascular neurosurgeon using the 3D-CTA images in 360-degree reconstruction in the planning of the preoperative surgical procedure for the treatment of brain aneurysm. In all patients, the virtual surgical approach was replicated in real-time surgery.
Results We analyzed 34 patients around 51 ± 8 years of age. Of these, 76.5% (n = 26) and 23.5% (n = 8) were males and females, respectively. Saccular aneurysms were the most frequent (85%), the Arteries affected by aneurysms were middle cerebral artery (n = 6), basilar tip (n = 6), vertebral artery in V3 and V4 (n = 6), and posterior cerebral artery (n = 5). The virtual surgical pterional approach was the most frequently used (50%), followed by fronto-orbito-zigomático (29%) and far lateral (15%) approaches. There were no intraoperative complications in any patient.
Conclusion Preoperative 3D virtual reality simulation is a great support tool to perform a safe surgical procedure in real-time for the treatment of simple and complex brain aneurysms.
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Affiliation(s)
- Antonio M. Zárate-Méndez
- Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - José M. Ramos-Delgado
- Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Juan C. Lujan-Guerra
- Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Carlos D. Rio-Olivares
- Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Luis E. Moreira-Ponce
- Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - José L. Aceves-Chimal
- Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
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Pflaeging M, Kabbasch C, Schlamann M, Pennig L, Juenger ST, Grunz JP, Timmer M, Brinker G, Goldbrunner R, Krischek B, Goertz L. Microsurgical Clipping versus Advanced Endovascular Treatment of Unruptured Middle Cerebral Artery Bifurcation Aneurysms After a "Coil-First" Policy. World Neurosurg 2021; 149:e336-e344. [PMID: 33607288 DOI: 10.1016/j.wneu.2021.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although intracranial aneurysms are increasingly treated endovascularly, microsurgical clipping has been the standard approach for middle cerebral artery (MCA) aneurysms. We compared microsurgical clipping and state-of-the-art endovascular treatment of unruptured MCA bifurcation aneurysms treated at a neurovascular center following a "coil-first" policy. METHODS This single-center study included 148 patients treated for 160 unruptured MCA bifurcation aneurysms. Technical success, complications, clinical outcome, and angiographic results were retrospectively compared. RESULTS Microsurgical clipping was performed for 120 MCA aneurysms (75%) and endovascular treatment for 40 (25%; conventional coiling: 8, stent-assisted coiling: 16, balloon-assisted coiling: 3, and flow-disruption: 13). Technical treatment success was higher in the clipping group (100%) than in the endovascular group (92.5%, P = 0.015). Overall, complications occurred in 16.7% for clipping and in 20.0% for endovascular treatment (P = 0.631). Major ischemic stroke rates were 4.2% in the clipping group and 7.5% in the endovascular group (P = 0.414). At 6 months, a favorable outcome was obtained by 99.2% after clipping and 95.0% after endovascular treatment (P = 0.154). The 6-month complete aneurysm occlusion rates were by trend higher in the clipping group (89.2%) than in the endovascular group (75.9%, P = 0.078). CONCLUSIONS Microsurgical clipping was associated with a higher technical success rate and tendentially higher complete occlusion than endovascular treatment, with no additional morbidity and similar clinical outcome. On the basis of these results, clipping proves to be the standard treatment option for MCA bifurcation aneurysms. However, endovascular treatment represents a safe and efficient alternative treatment option for patients.
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Affiliation(s)
- Muriel Pflaeging
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lenhard Pennig
- Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Theresa Juenger
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Peter Grunz
- Institute for Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Marco Timmer
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gerrit Brinker
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Boris Krischek
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Neurosurgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Lukas Goertz
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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Goertz L, Hamisch C, Kabbasch C, Borggrefe J, Hof M, Dempfle AK, Lenschow M, Stavrinou P, Timmer M, Brinker G, Goldbrunner R, Krischek B. Impact of aneurysm shape and neck configuration on cerebral infarction during microsurgical clipping of intracranial aneurysms. J Neurosurg 2020; 132:1539-1547. [PMID: 30978687 DOI: 10.3171/2019.1.jns183193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cerebral infarction is a significant cause of morbidity and mortality related to microsurgical clipping of intracranial aneurysms. The objective of this study was to determine the impact of aneurysm shape and neck configuration on cerebral infarction after aneurysm surgery. METHODS The authors retrospectively reviewed consecutive cases of ruptured and unruptured aneurysms treated with microsurgical clipping at their institution between 2010 and 2018. Three-dimensional reconstructions from preoperative computed tomography and digital subtraction angiography were used to determine aneurysm shape (regular/complex) and neck configuration (regular/irregular). Morphological and procedure-related risk factors for cerebral infarction were identified using univariate and multivariate statistical analyses. RESULTS Among 243 patients with 252 aneurysms (148 ruptured, 104 unruptured), the overall cerebral infarction rate was 17.1%. Infarction tended to occur more often in aneurysms with complex shape (p = 0.084). Likewise, aneurysms with an irregular neck had a significantly higher rate of infarction (37.5%) than aneurysms with regular neck configuration (10.1%, p < 0.001). Aneurysms with an irregular neck were associated with a higher rate of intraoperative rupture (p = 0.003) and temporary parent artery occlusion (p = 0.037). In the multivariate analysis, irregular neck configuration was identified as an independent risk factor for infarction (OR 4.2, 95% CI 1.9-9.4, p < 0.001), whereas the association between aneurysm shape and infarction was not significant (p = 0.966). CONCLUSIONS Irregular aneurysm neck configuration represents an independent risk factor for cerebral infarction during microsurgical clipping of both ruptured and unruptured aneurysms.
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Affiliation(s)
| | | | | | - Jan Borggrefe
- 2Department of Neuroradiology, University Hospital of Cologne, Germany
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Goertz L, Krischek B, Reiner M, Goldbrunner R, Brinker G. Penumbral Salvage by Delayed Clip Reposition 19 Hours After Cerebral Aneurysm Clipping-Induced Ischemia Results in Neurologic Restitution-Correlation with Indocyanine Green Videoangiography and FLOW 800 Measurements. World Neurosurg 2020; 138:61-67. [PMID: 32142943 DOI: 10.1016/j.wneu.2020.02.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cerebral infarction because of parent artery stenosis represents a potential complication of microsurgical aneurysm clipping. CASE DESCRIPTION We report a case of a 60-year-old woman that developed left-sided hemiparesis and aphasia 9 hours after clipping of an unruptured middle cerebral artery aneurysm with heavy calcification of the aneurysm neck. Angiographic workup revealed a marked parent artery stenosis, which occurred presumably because of thrombus generation at the reconstructed aneurysm neck. Revision surgery with relocation of the aneurysm clip was ultimately performed 19 hours after symptom onset. Although follow-up computed tomography scan showed a small cerebral infarction, the patient recovered fully from surgery. CONCLUSIONS This case shows that relocation of the aneurysm clip in case of vessel stenosis can lead to penumbral salvage, even when performed more than 6 hours after symptom onset.
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Affiliation(s)
- Lukas Goertz
- University of Cologne, Faculty of Medicine and University Hospital, Center for Neurosurgery, Department of General Neurosurgery, Cologne, Germany.
| | - Boris Krischek
- University of Cologne, Faculty of Medicine and University Hospital, Center for Neurosurgery, Department of General Neurosurgery, Cologne, Germany
| | - Michael Reiner
- University of Cologne, Faculty of Medicine and University Hospital, Center for Neurosurgery, Department of General Neurosurgery, Cologne, Germany
| | - Roland Goldbrunner
- University of Cologne, Faculty of Medicine and University Hospital, Center for Neurosurgery, Department of General Neurosurgery, Cologne, Germany
| | - Gerrit Brinker
- University of Cologne, Faculty of Medicine and University Hospital, Center for Neurosurgery, Department of General Neurosurgery, Cologne, Germany
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Goertz L, Pflaeging M, Hamisch C, Kabbasch C, von Spreckelsen N, Laukamp K, Pennig L, Wetzel C, Brinker G, Goldbrunner R, Krischek B. Identifying Predictors for Aneurysm Remnants After Clipping by Morphometric Analysis and Proposal of a Novel Risk Score. World Neurosurg 2019; 136:e300-e309. [PMID: 31901493 DOI: 10.1016/j.wneu.2019.12.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Although the risk of aneurysm remnants after microsurgical clipping is generally low, complete aneurysm occlusion is not always guaranteed. We performed a morphometric analysis of intracranial aneurysms to identify predictors for aneurysm remnants and to propose a novel risk score. METHODS This is a retrospective, single-center analysis of consecutive patients with ruptured and unruptured aneurysms who underwent microsurgical clipping and postoperative digital subtraction angiography between 2010 and 2018. Based on preoperative rotational angiography, distinct morphologic aneurysm characteristics were determined and correlated with postoperative angiographic results. Factors predictive in the univariate and multivariate analyses were determined to establish a risk score for postoperative remnants after aneurysm clipping. RESULTS Among 140 patients with 166 clipped aneurysms, aneurysm remnants were present in 19.9%. In the multivariate analysis, ruptured aneurysm status (odds ratio [OR], 7.8; 95% confidence interval [CI], 1.7-36; P < 0.01) and increased aspect ratio (OR, 1.9; 95% CI, 1.0-4.0; P = 0.07) were associated with postoperative aneurysm remnants. Anterior communicating artery location (P = 0.02), internal carotid artery location (P = 0.06), increased aneurysm inclination angle (P < 0.01), and irregular aneurysm shape (P = 0.07) were further predictors for aneurysm remnants in the univariate analysis. These factors were weighted and included into a risk sum score for postoperative aneurysm remnants (range, 0-8 points), which performed with good accuracy (area under the curve = 0.807). CONCLUSIONS After external validation of the proposed risk score, it could help identify cases requiring angiographic control after aneurysm surgery.
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Affiliation(s)
- Lukas Goertz
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany.
| | - Muriel Pflaeging
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
| | - Christina Hamisch
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
| | - Christoph Kabbasch
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
| | - Niklas von Spreckelsen
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany; Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kai Laukamp
- Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany; Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Department of Radiology, Case Western Reserve University Cleveland, Ohio, USA
| | - Lenhard Pennig
- Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Christian Wetzel
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
| | - Gerrit Brinker
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
| | - Roland Goldbrunner
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
| | - Boris Krischek
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
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Goertz L, Hof M, Timmer M, Schulte AP, Kabbasch C, Krischek B, Stavrinou P, Reiner M, Goldbrunner R, Brinker G. Application of Intraoperative FLOW 800 Indocyanine Green Videoangiography Color-Coded Maps for Microsurgical Clipping of Intracranial Aneurysms. World Neurosurg 2019; 131:e192-e200. [DOI: 10.1016/j.wneu.2019.07.113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 11/29/2022]
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12
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Goertz L, Hamisch C, Pflaeging M, Kabbasch C, Borggrefe J, Timmer M, Stravrinou P, Goldbrunner R, Brinker G, Mpotsaris A, Krischek B. Angiographic Characteristics of Lobulated Intracranial Aneurysms. World Neurosurg 2019; 131:e353-e361. [DOI: 10.1016/j.wneu.2019.07.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 12/31/2022]
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Treatment of Recurrent and Residual Aneurysms with the Woven EndoBridge Device: Analysis of 11 Patients and Review of the Literature. World Neurosurg 2019; 129:e677-e685. [DOI: 10.1016/j.wneu.2019.05.248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/19/2022]
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