Microsurgical Clipping of Unruptured Anterior Circulation Aneurysms-A Global Multicenter Investigation of Perioperative Outcomes

Jennifer Sauvigny, Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Richard Drexler, Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Tobias F. Pantel, Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Franz L. Ricklefs, Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
John E. Wanebo, 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.
Aminaa Sanchin, Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Nils Hecht, Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Peter Vajkoczy, Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Kunal Raygor, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Daniel Tonetti, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Adib Abla, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Kareem El Naamani, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Stavropoula I. Tjoumakaris, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Pascal Jabbour, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Brian T. Jankowitz, Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
Mohamed M. Salem, Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
Jan-Karl Burkhardt, Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
Arthur Wagner, Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany.
Maria Wostrack, Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany.
Jens Gempt, Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Bernhard Meyer, Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany.
Michael Gaub, Department of Neurosurgery, University of Texas Health and Science Center at San Antonio, San Antonio, Texas, USA.
Justin R. Mascitelli, Department of Neurosurgery, University of Texas Health and Science Center at San Antonio, San Antonio, Texas, USA.
Philippe Dodier, Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
Gerhard Bavinzski, Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
Karl Roessler, Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
Nico Stroh, Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
Matthias Gmeiner, Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
Andreas Gruber, Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria.

Document Type

Article

Abstract

BACKGROUND AND OBJECTIVES: Microsurgical aneurysm repair by clipping continues to be highly important despite increasing endovascular treatment options, especially because of inferior occlusion rates. This study aimed to present current global microsurgical treatment practices and to identify risk factors for complications and neurological deterioration after clipping of unruptured anterior circulation aneurysms. METHODS: Fifteen centers from 4 continents participated in this retrospective cohort study. Consecutive patients who underwent elective microsurgical clipping of untreated unruptured intracranial aneurysm between January 2016 and December 2020 were included. Posterior circulation aneurysms were excluded. Outcome parameters were postsurgical complications and neurological deterioration (defined as decline on the modified Rankin Scale) at discharge and during follow-up. Multivariate regression analyses were performed adjusting for all described patient characteristics. RESULTS: Among a total of 2192 patients with anterior circulation aneurysm, complete occlusion of the treated aneurysm was achieved in 2089 (95.3%) patients at discharge. The occlusion rate remained stable (94.7%) during follow-up. Regression analysis identified hypertension (P < .02), aneurysm diameter (P < .001), neck diameter (P < .05), calcification (P < .01), and morphology (P = .002) as preexisting risk factors for postsurgical complications and neurological deterioration at discharge. Furthermore, intraoperative aneurysm rupture (odds ratio 2.863 [CI 1.606-5.104]; P < .01) and simultaneous clipping of more than 1 aneurysm (odds ratio 1.738 [CI 1.186-2.545]; P < .01) were shown to be associated with an increased risk of postsurgical complications. Yet, none of the surgical-related parameters had an impact on neurological deterioration. Analyzing volume-outcome relationship revealed comparable complication rates (P = .61) among all 15 participating centers. CONCLUSION: Our international, multicenter analysis presents current microsurgical treatment practices in patients with anterior circulation aneurysms and identifies preexisting and surgery-related risk factors for postoperative complications and neurological deterioration. These findings may assist in decision-making for the optimal therapeutic regimen of unruptured anterior circulation aneurysms.

Publication Date

1-19-2024

Publication Title

Neurosurgery

E-ISSN

1524-4040

Volume

94

Issue

6

First Page

1218

Last Page

26

PubMed ID

38240568

Digital Object Identifier (DOI)

10.1227/neu.0000000000002829

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