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Clinical Research
Available online 5 August 2024
Microsurgical clipping of unruptured intracranial aneurysms: Clinical and radiological outcomes
Aneurismas intracraneales no rotos tratados con microcirugía: análisis de resultados clínicos y radiológicos
Silvia Vázquez Sufuentes
Corresponding author
, Loreto Esteban Estallo, Jesús Moles Herbera, Luis Manuel González Martínez, Jouke Sieds van Popta, Juan Casado Pellejero
Servicio de Neurocirugía, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Tables (4)
Table 1. Location of unruptured aneurysms treated by microsurgery.
Table 2. Descriptive analysis comparing patients who had one aneurysm or more than one aneurysm treated in the same intervention.
Table 3. Complications and functional status at the end of the study in patients who underwent microsurgical intervention for unruptured aneurysms.
Table 4. Univariate analysis of ischaemic and total complications and postoperative functional status.
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Abstract
Background and objectives

The prevalence of unruptured intracranial aneurysms is 1–3%. The annual rupture rate increases in patients with multiple aneurysms that presented a previous hemorrhage from another aneurysm.

Objectives

To evaluate outcomes of clipping unruptured aneurysms, comparing patients with single or multiple aneurysms clipped, describe the complications related to surgery and to identify risk factors predicting an unfavorable outcome.

Materials and methods

Retrospective study including patients who underwent clipping of unruptured aneurysms between 2020–2023 at our center. Occlusion rate, complications, and functional outcome were analyzed. Risk factors for poor prognosis are identified using univariate model.

Results

82 patients with 114 aneurysms were treated with microsurgery. Multiple aneurysms were clipped in 22 patients. A mini-open approach was used in 86,5% of cases. Complete occlusion in angio3D was found in 78.6% of clipped aneurysms. Complication rate was 12.2%, including asymptomatic cases. Mortality was 0%. The probability of 1 point mRS worsening was 7.3% and 2 or more points was 1.2%, with a good functional outcome in 98.9%. Clipping multiple aneurysms, miniopen approaches, or surgery in patients with previous subarachnoid hemorrhage did not increase the risk of complications. Posterior circulation aneurysms surgery increased the risk of ischemia.

Conclusions

The management for unruptured intracranial aneurysms should be multimodal and based on clinical and radiological outcomes. Microsurgery is a valid and safe technique, with 0% mortality and bleeding rates and 1,2% rate of severe morbidity in our series.

Keywords:
Clipping
Unruptured intracranial aneurysms
Multiple intracranial aneurysms
Outcomes
Complications
Abbreviations:
AINR
HSA
HTA
PHASES
ELAPSS
UIATS
TC
LSO
mRS
OR
ACM
ACI
A1
M1
AcoA
A2
AcoP
AB-ACS
ACA
AchoA
FD
MIS
Resumen
Antecedentes y objetivo

La prevalencia de aneurismas intracraneales no rotos es de un 1-3%. La tasa de ruptura anual aumenta en pacientes con aneurismas múltiples que han sufrido una hemorragia de uno de ellos. Los objetivos son evaluar los resultados quirúrgicos del clipaje de aneurismas no rotos, comparando pacientes en los que se clipa un único o varios y describir las complicaciones de las intervenciones de aneurismas no rotos estableciendo los factores de riesgo de un pronóstico desfavorable.

Materiales y métodos

Estudio retrospectivo que incluye pacientes intervenidos de aneurismas no rotos mediante microcirugía entre 2020-2023 en nuestro centro. Se analiza la tasa de cierre, las complicaciones y el resultado funcional de los pacientes. Se identifican los factores de riesgo de mal pronóstico con un modelo univariante.

Resultados

Se intervinieron 82 pacientes con 114 aneurismas. En 22 pacientes se clipó más de un aneurisma durante la intervención. El 86,5% de las intervenciones se realizaron mediante abordaje miniopen. El 78,6% de los aneurismas seguidos por arteriografía 3D presentan cierre completo. La tasa de complicaciones fue del 12,2%, incluyendo asintomáticas. La mortalidad fue del 0%. La probabilidad de empeorar el mRS 1 punto fue del 7,3% y 2 o más del 1,2%, con buen resultado funcional en el 98,9%. El clipaje de varios aneurismas en una misma intervención, empleo de minicraneotomías o la cirugía en pacientes con hemorragia subaracnoidea previa no incrementó el riesgo de complicaciones. La cirugía de aneurismas de circulación posterior aumentó el riesgo de isquemia.

Conclusiones

La indicación de cirugía de aneurismas intracraneales no rotos debe de ser consensuada multidisciplinarmente, conociendo resultados clínicos y radiológicos. La microcirugía es una técnica válida y segura, con una mortalidad 0% y una morbilidad severa del 1,2% en nuestra serie.

Palabras clave:
Clipaje
Aneurismas intracraneales no rotos
Aneurismas múltiples
Pronóstico
Complicaciones

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