Document Detail


The role of surgery when endovascular treatment is considered the first choice therapy for ruptured intracranial aneurysms.
MedLine Citation:
PMID:  18636049     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: Nowadays endovascular therapy is more and more considered as first choice treatment for ruptured intracranial aneurysms. The aim of this study was to understand the impact that endovascular treatment (EVT), chosen as first therapeutic strategy, has had in the selection of ruptured intracranial aneurysms submitted to surgery at our Institution and what role neurosurgeons still play in this setting. METHODS: From 1998 to 2002, 272 consecutive patients were treated at the Hospital of Toulouse for ruptured intracranial aneurysms: 222 by embolization and 50 by surgery. The two groups were homogeneous for sex, age and aneurysms multiplicity. RESULTS: The patients of the surgical group had a worst clinical-radiological status at the treatment time than those treated by EVT. Clipping was performed for different reasons: 16% for failure of attempted EVT; 32% for intracranial hematoma requiring surgical evacuation; 30% for aneurysm morphology unsuitable for EVT and 22% for absence of the endovascular operator. Aneurysms of the middle cerebral artery (MCA) represented the main surgical group. The aneurysms judged unsuitable for EVT and addressed to surgery had often a complex morphology representing a challenge also for surgery. Mid-term outcome is significantly better for patients treated by EVT. CONCLUSION: The results show that microsurgery continues to have a role in the treatment of ruptured intracranial aneurysms even when EVT is the first choice. The precarious clinical conditions of the patients submitted to surgery and the frequent complexity of their aneurysms explain their worst outcome. This would advise training dedicated vascular Neurosurgeons to guaranty a high level treatment when EVT is not possible.
Authors:
C Giussani; M Mejdoubi; M Tremoulet; F E Roux
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of neurosurgical sciences     Volume:  52     ISSN:  0390-5616     ISO Abbreviation:  J Neurosurg Sci     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-07-18     Completed Date:  2009-01-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0432557     Medline TA:  J Neurosurg Sci     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  61-9     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, University Hospital Centres, Toulouse, France. carlo.giussani@libero.it
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Aneurysm, Ruptured / pathology,  physiopathology,  surgery*
Cerebral Arteries / pathology,  physiopathology,  surgery
Child
Child, Preschool
Clinical Protocols
Endarterectomy / standards,  statistics & numerical data
Female
Humans
Intracranial Aneurysm / pathology,  physiopathology,  surgery*
Magnetic Resonance Imaging
Male
Microsurgery / standards,  statistics & numerical data
Middle Aged
Neurosurgical Procedures / standards*,  statistics & numerical data*
Outcome Assessment (Health Care)
Retrospective Studies
Risk Assessment
Subarachnoid Hemorrhage / pathology,  physiopathology,  surgery
Treatment Outcome
Vascular Surgical Procedures / standards*,  statistics & numerical data*
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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