User: Guest  Login
Document type:
journal article 
Author(s):
Maldaner, Nicolai; Guhl, Susanne; Mielke, Dorothee; Musahl, Christian; Schmidt, Nils Ole; Wostrack, Maria; Rüfenacht, Daniel A; Vajkoczy, Peter; Dengler, Julius; Giant Intracranial Aneurysm Study Group 
Title:
Changes in volume of giant intracranial aneurysms treated by surgical strategies other than direct clipping. 
Abstract:
Giant intracranial aneurysms (GIA) are often not eligible for direct clip occlusion. Surgical alternatives include partial clip occlusion or the placement of a cerebrovascular bypass or the combination of both. These alternative indirect strategies are expected to lead to a decrease in GIA volume over time rather than instantaneously. To examine whether this is the case, we analyzed follow-up imaging results 1 year after surgery.We retrospectively screened the prospective GIA Registry's imaging database for anterior circulation GIA treated by surgical strategies other than direct clipping. We measured pre- and 1-year post-treatment GIA volume, lateral ventricle volume (LVV), and mid-line shift (MLS) in 19 cases.After a mean follow-up of 466 days (standard deviation ±171) GIA volumes decreased from 9.6 cm(3) (interquartile range (IQR) 6.1-14.1) to 4.3 cm(3) (IQR 2.9-5.7; p< 0.01). Ipsilateral LVV increased from 8.6 cm(3) (IQR 6.4-24.9) to 16.0 cm(3) (IQR 9.1-27.2; p< 0.01) while contralateral LVV increased from 10.3 cm(3) (IQR 7.3-20.1) to 11.7 cm(3) (IQR 8.2-19.4; p = 0.02). MLS changed from 0.1 mm (IQR -1.9 to 2.0) to -0.9 mm (IQR -1.8 to 0.4; p = 0.03). The decrease in GIA volume correlated with the increase in ipsilateral LVV (rs = 0.60; p = 0.01) but not with the changes in MLS (rs = 0.41; p = 0.08).In our patient cohort, surgical strategies other that direct clipping for the treatment of anterior circulation GIA lead to a significant decrease in GIA volume over time. The resulting decrease in mass effect was more sensitively monitored by the measurement of changes in ipsilateral LVV than changes in MLS.http://www.clinicaltrials.gov . Unique identifier: NCT02066493. 
Journal title abbreviation:
Acta Neurochir (Wien) 
Year:
2015 
Journal volume:
157 
Journal issue:
Pages contribution:
1117-23; discussion 1123 
Language:
eng 
Print-ISSN:
0001-6268 
TUM Institution:
Neurochirurgische Klinik und Poliklinik