Skull Base 2011; 21(1): 037-046
DOI: 10.1055/s-0030-1263285
ORIGINAL ARTICLE

© Thieme Medical Publishers

Evaluation of the Prognostic Indicators of Giant Intracranial Aneurysms

Prasad S.S.V Vannemreddy1 , 2 , Ali Nourbakhsh2 , Anil Nanda2
  • 1Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India
  • 2Louisiana State Health Sciences Center, Shreveport, Louisiana
Further Information

Publication History

Publication Date:
16 August 2010 (online)

ABSTRACT

The indicators of poor outcome in giant intracranial aneurysms have been the subject of several studies in the literature. We conducted a retrospective analysis to evaluate the predictors of poor outcome in giant intracranial aneurysms. We studied consecutive cases with aneurysms admitted over a 9-year period in our institution. All the aneurysms were treated with clipping. Patient demographics, clinical profile, and aneurysm characteristics were evaluated in a multivariate analysis as probable indicators of Glasgow Outcome Scale (GOS) score. The outcome of the aneurysms (GOS score) was compared with the remaining non-giant aneurysms. A total of 41 giant and 348 non-giant aneurysms were identified in our series. In the multivariate analysis, the indicators of poor outcome were identified as poor clinical grade (p < 0.0004), intraoperative rupture (p < 0.007), and posterior circulation of the aneurysms (p < 0.01). Non-giant aneurysms had a better outcome compared with the giant aneurysms (p < 0.01). Giant aneurysms impose a relatively higher risk of morbidity and mortality to the patients. The predictors of the postsurgical outcome of the giant aneurysms include the clinical condition of the patient, location of the aneurysm, and intraoperative rupture.

REFERENCES

  • 1 Deruty R, Pelissou-Guyotat I, Mottolese C, Amat D, Bognar L. Level of consciousness and age as prognostic factors in aneurysmal SAH.  Acta Neurochir (Wien). 1995;  132 1-8
  • 2 Kassell N F, Torner J C, Haley Jr E C, Jane J A, Adams H P, Kongable G L. The international cooperative study on the timing of aneurysm surgery: Part 1—Overall management result.  J Neurosurg. 1990;  73 18-36
  • 3 Kassell N F, Torner J C, Jane J A, Haley Jr E C, Adams H P. The international cooperative study on the timing of aneurysm surgery: Part 2—Surgical result.  J Neurosurg. 1990;  73 37-47
  • 4 Hunt W E, Hess R M. Surgical risk as related to time of intervention in the repair of intracranial aneurysms.  J Neurosurg. 1968;  28 14-20
  • 5 Disney L, Weir B, Grace M. Factors influencing the outcome of aneurysm rupture in poor grade patients: a prospective series.  Neurosurgery. 1988;  23 1-9
  • 6 Fisher C M, Kistler J P, Davis J M. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning.  Neurosurgery. 1980;  6 1-9
  • 7 Wiebers D O, Whisnant J P, Huston III J International Study of Unruptured Intracranial Aneurysms Investigators et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment.  Lancet. 2003;  362 103-110
  • 8 Molyneux A, Kerr R, Stratton I International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial.  Lancet. 2002;  360 1267-1274
  • 9 Drake C G. Giant intracranial aneurysms: experience with surgical treatment in 174 patients.  Clin Neurosurg. 1979;  26 12-95
  • 10 Sundt Jr T M. Surgical Techniques for Saccular and Giant Intracranial Aneurysms. Baltimore: Williams & Wilkins; 1990
  • 11 Sundt Jr T M, Piepgras D G, Fode N C, Meyer F B. Giant intracranial aneurysms.  Clin Neurosurg. 1991;  37 116-154
  • 12 Drake C G, Peerless S J, Ferguson G G. Hunterian proximal arterial occlusion for giant aneurysms of the carotid circulation.  J Neurosurg. 1994;  81 656-665
  • 13 Steinberg G K, Drake C G, Peerless S J. Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms. Immediate results and long-term outcome in 201 patients.  J Neurosurg. 1993;  79 161-173
  • 14 Mendelow A D. Pathophysiology of delayed ischaemic dysfunction after subarachnoid haemorrhage: experimental and clinical data.  Acta Neurochir Suppl (Wien). 1988;  45 7-10
  • 15 Piepgras D G, Khurana V G, Whisnant J P. Ruptured giant intracranial aneurysms Part II A retrospective analysis of timing and outcome of surgical treatment.  J Neurosurg. 1998;  88 430-435
  • 16 Sundt Jr T M, Szurszewski J, Sharbrough F W. Physiological considerations important for the management of vasospasm.  Surg Neurol. 1977;  7 259-267
  • 17 Hauck E F, Wohlfeld B, Welch B G, White J A, Samson D. Clipping of very large or giant unruptured intracranial aneurysms in the anterior circulation: an outcome study.  J Neurosurg. 2008;  109 1012-1018
  • 18 Orz Y I, Hongo K, Tanaka Y et al.. Risks of surgery for patients with unruptured intracranial aneurysms.  Surg Neurol. 2000;  53 21-27 discussion 27-29
  • 19 Nanda A, Vannemreddy P. Management of intracranial aneurysms: factors that influence clinical grade and surgical outcome.  South Med J. 2003;  96 259-263
  • 20 Raaymakers T W, Rinkel G J, Limburg M, Algra A. Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis.  Stroke. 1998;  29 1531-1538
  • 21 Ogilvy C S, Carter B S. A proposed comprehensive grading system to predict outcome for surgical management of intracranial aneurysms.  Neurosurgery. 1998;  42 959-968 discussion 968-970
  • 22 Ogilvy C S, Carter B S. Stratification of outcome for surgically treated unruptured intracranial aneurysms.  Neurosurgery. 2003;  52 82-87 discussion 87-88
  • 23 Khanna R K, Malik G M, Qureshi N. Predicting outcome following surgical treatment of unruptured intracranial aneurysms: a proposed grading system.  J Neurosurg. 1996;  84 49-54
  • 24 Rosenorn J, Eskesen V. Patients with ruptured intracranial saccular aneurysms: clinical features and outcome according to the size.  Br J Neurosurg. 1994;  8 73-78
  • 25 Seifert V, Raabe A, Stolke D. Management-related morbidity and mortality in unselected aneurysms of the basilar trunk and vertebrobasilar junction.  Acta Neurochir (Wien). 2001;  143 343-348 discussion 348-349
  • 26 Barrow D L, Cawley C M. Surgical management of complex intracranial aneurysms.  Neurol India. 2004;  52 156-162
  • 27 Choi I S, David C. Giant intracranial aneurysms: development, clinical presentation and treatment.  Eur J Radiol. 2003;  46 178-194
  • 28 Locksley H B. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations.  J Neurosurg. 1996;  25 321-368
  • 29 Sharma B S, Gupta A, Ahmad F U, Suri A, Mehta V S. Surgical management of giant intracranial aneurysms.  Clin Neurol Neurosurg. 2008;  110 674-681
  • 30 Solomon R A, Fink M E, Pile-Spellman J. Surgical management of unruptured intracranial aneurysms.  J Neurosurg. 1994;  80 440-446
  • 31 Hosobuchi Y. Giant intracranial aneurysms. In: Wilkinson R H, Rengachari S S, eds. Neurosurgery. 2nd ed. New York: McGraw-Hill; 1985: 1404-1414
  • 32 Heros R G. Giant aneurysms. In: Ojemann R G, Ogilry C S, Crowell R M, et al, eds. Surgical Management of Neurovascular Disease. 3rd ed. Baltimore: Williams and Wilkins; 1995: 323
  • 33 Lawton M T, Spetzler R F. Surgical management of giant intracranial aneurysms: experience with 171 patients.  Clin Neurosurg. 1995;  42 245-266
  • 34 Symon L. Surgical experiences with giant intracranial aneurysms.  Acta Neurochir (Wien). 1992;  118 53-58
  • 35 Sundt Jr T M, Kobayashi S, Fode N C, Whisnant J P. Results and complications of surgical management of 809 intracranial aneurysms in 722 cases. Related and unrelated to grade of patient, type of aneurysm, and timing of surgery.  J Neurosurg. 1982;  56 753-765
  • 36 Debrun G, Fox A, Drake C, Peerless S, Girvin J, Ferguson G. Giant unclippable aneurysms: treatment with detachable balloons.  AJNR Am J Neuroradiol. 1981;  2 167-173
  • 37 Fox A J, Viñuela F, Pelz D M et al.. Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms.  J Neurosurg. 1987;  66 40-46
  • 38 Kodama N, Suzuki J. Surgical treatment of giant aneurysms.  Neurosurg Rev. 1982;  5 155-160
  • 39 Byrne J V, Adams C BT, Kerr R SC, Molyneux A J. Endosaccular treatment of inoperable intracranial aneurysms with platinum coils.  Br J Neurosurg. 1995;  9 585-592
  • 40 Gruber A, Killer M, Bavinzski G, Richling B. Clinical and angiographic results of endosaccular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single-center experience.  Neurosurgery. 1999;  45 793-803 discussion 803-804
  • 41 Sluzewski M, Menovsky T, van Rooij W J, Wijnalda D. Coiling of very large or giant cerebral aneurysms: long-term clinical and serial angiographic results.  AJNR Am J Neuroradiol. 2003;  24 257-262
  • 42 Popadić A, Witzmann A, Amann T et al.. The value of intraoperative angiography in surgery of intracranial aneurysms: a prospective study in 126 patients.  Neuroradiology. 2001;  43 466-471
  • 43 Ogilvy C S, Cheung A C, Mitha A P, Hoh B L, Carter B S. Outcomes for surgical and endovascular management of intracranial aneurysms using a comprehensive grading system.  Neurosurgery. 2006;  59 1037-1042 discussion 1043
  • 44 Botterell E H, Lougheed W M, Scott J W, Vandewater S L. Hypothermia, and interruption of carotid, or carotid and vertebral circulation, in the surgical management of intracranial aneurysms.  J Neurosurg. 1956;  13 1-42
  • 45 Gerber C J, Lang D A, Neil-Dwyer G, Smith P W. A simple scoring system for accurate prediction of outcome within four days of a subarachnoid haemorrhage.  Acta Neurochir (Wien). 1993;  122 11-22
  • 46 Rice B J, Peerless S J, Drake C G. Surgical treatment of unruptured aneurysms of the posterior circulation.  J Neurosurg. 1990;  73 165-173
  • 47 Sanai N, Tarapore P, Lee A C, Lawton M T. The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular era.  Neurosurgery. 2008;  62 1236-1249 discussion 1249-1253

Prasad S.S.V VannemreddyM.D. M.S. M.Ch. 

LSUHSC-Neurosurgery, 1501 Kings' Highway, Shreveport

LA 71103

Email: prasad4458@hotmail.com

    >