Frequency and risk factors for postoperative aneurysm residual after microsurgical clipping
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ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - ANEURYSM
Frequency and risk factors for postoperative aneurysm residual after microsurgical clipping Kathrin Obermueller 1 & Isabel Hostettler 1 & Arthur Wagner 1 & Tobias Boeckh-Behrens 2 & Claus Zimmer 2 & Jens Gempt 1 & Bernhard Meyer 1 & Maria Wostrack 1 Received: 17 July 2020 / Accepted: 27 October 2020 # The Author(s) 2020
Abstract Objective Aneurysm residuals after clipping are a well-known problem, but the course of aneurysm remnants in follow-up is not well studied. No standards or follow-up guidelines exist for treatment of aneurysm remnants. The aim of this study was to evaluate the risk factors for postoperative aneurysm remnants and their changes during follow-up. Methods We performed a retrospective analysis of 666 aneurysms treated via clipping in our hospital from 2006 to 2016. Postoperative and follow-up angiographic data were analyzed for aneurysm remnants and regrowth. Clinical parameters and aneurysm-specific characteristics were correlated with radiological results. Results The frequency of aneurysm residuals was 12% (78/666). Aneurysms located in the middle cerebral artery (p = 0.02) showed a significantly lower risk for incomplete aneurysm occlusion. Larger aneurysms with a diameter of 11–25 mm (p = 0.005) showed a significantly higher risk for incomplete aneurysm occlusion. Five patients underwent re-clipping during the same hospital stay. Remnants were stratified based on morphological characteristics into “dog ears” (n = 60) and “broad based” (n = 13). The majority of the “dog ears” stayed stable, decreased in size, or vanished during follow-up. Broad-based remnants showed a higher risk of regrowth. Conclusions A middle cerebral artery location seems to lower the risk for the incomplete clip occlusion of an aneurysm. Greater aneurysm size (11–25 mm) is associated with a postoperative aneurysm remnant. The majority of “dog-ear” remnants appear to remain stable during follow-up. In these cases, unnecessarily frequent angiographic checks could be avoided. By contrast, broadbased residuals show a higher risk of regrowth that requires close imaging controls if retreatment cannot be performed immediately. Keywords Intracranial aneurysm . Aneurysm clipping . Aneurysm residual . Aneurysm remnant . Aneurysm regrowth
Abbreviations ACA DSA Fig. FU H&H
Anterior cerebral artery Digital subtraction angiography Figure Follow-up Hunt and Hess grade
This article is part of the Topical Collection on Vascular Neurosurgery Aneurysm
ICA ICD ICG angiography MCA PC SAH SD Tab.
Internal carotid artery International Statistical Classification of Diseases and Related Health Problems Indocyanine green angiography Middle cerebral artery Posterior circulation Subarachnoid hemorrhage Standard deviation Table
* Kathrin Obermueller [email protected]
Introduction 1
Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675 Munich, Germany
2
Department of Neuroradiology, Klinikum rechts der Isar, Technical Un
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