Mortality After Microsurgical Treatment of Unruptured Intracranial Aneurysms in the Modern Era

Authors

Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Stefan W. Koester, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Emmajane G. Rhodenhiser, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Lea Scherschinski, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Katherine Karahalios, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Brandon K. Hoglund, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Ethan A. Winkler, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Joelle N. Hartke, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Olga Ciobanu-Caraus, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Anant Naik, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Laura Beatriz Lopez Lopez, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Jarrod D. Rulney, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Robert F. Spetzler, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@barrowneuro.org.Follow

Document Type

Article

Abstract

BACKGROUND: The incidence of mortality after treatment of unruptured intracranial aneurysms (UIAs) has been described historically. However, many advances in microsurgical treatment have since emerged, and most available data are outdated. We analyzed the incidence of mortality after microsurgical treatment of patients with UIAs treated in the past decade. METHODS: The medical records of all patients with UIAs who underwent elective treatment at our large quaternary center from January 1, 2014, to December 31, 2020, were reviewed retrospectively. We analyzed mortality at discharge and 1-year follow-up as the primary outcome using univariate to multivariable progression with P < 0.20 inclusion. RESULTS: During the 7-year study period, 488 patients (mean [SD] age = 58 [12] years) had UIAs treated microsurgically. Of these patients, 61 (12.5%) had a prior subarachnoid hemorrhage. One patient (0.2%) with a dolichoectatic vertebrobasilar aneurysm died while hospitalized, and 7 other patients (8 total; 1.6%) were determined to have died at 1-year follow-up (1 trauma, 2 myocardial infarction, 2 cerebrovascular accident, 1 pulmonary embolism, and 1 subdural hematoma complicated by abscess). On univariate analysis, significant risk factors for mortality at follow-up included diabetes mellitus, preoperative anticoagulant or antiplatelet use, aneurysm calcification, nonsaccular aneurysm, and higher American Society of Anesthesiologists grades (all P < 0.03). On multivariable logistic regression analysis, only nonsaccular aneurysms and higher American Society of Anesthesiologists grades were predictors of mortality. CONCLUSIONS: A low mortality rate is associated with recent microsurgical treatment of UIAs. However, nonsaccular aneurysms and higher American Society of Anesthesiologists grades appear to be predictors of mortality.

Medical Subject Headings

Humans; Middle Aged; Intracranial Aneurysm (therapy); Treatment Outcome; Retrospective Studies; Neurosurgical Procedures; Subarachnoid Hemorrhage (surgery)

Publication Date

12-1-2023

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

180

First Page

e415

Last Page

e421

PubMed ID

37769845

Digital Object Identifier (DOI)

10.1016/j.wneu.2023.09.081

Recommended Citation

Catapano, Joshua S.; Koester, Stefan W.; Rhodenhiser, Emmajane G.; Scherschinski, Lea; Karahalios, Katherine; Hoglund, Brandon K.; Winkler, Ethan A.; Hartke, Joelle N.; Ciobanu-Caraus, Olga; Naik, Anant; Lopez Lopez, Laura Beatriz; Rulney, Jarrod D.; Spetzler, Robert F.; and Lawton, Michael T., "Mortality After Microsurgical Treatment of Unruptured Intracranial Aneurysms in the Modern Era" (2023). Neurosurgery. 1946.
https://scholar.barrowneuro.org/neurosurgery/1946