129 A Multicenter International Study of Surgical Clipping for Unruptured Very Small Intracranial Aneurysms. Issue Volume 61:Issue CN Supp. 1(2014)Supplement (1st August 2014)

• Record Type: Journal Article
• Authors: Bruneau, Michael; Amin-Hanjani, Sepideh; Koroknay-Pal, Paivi; Bijlenga, Philippe; Jahromi, Behnam Rezai; Lehto, Hanna; Kivisaari, Riku; Schaller, Karl; Charbel, Fady T.; Kahn, Sajeel; Melot, Christian; Niemela, Mika Risto; Hernesniemi, Juha Antero
• Is Part Of: Neurosurgery. Volume 61:Issue CN Supp. 1(2014)Supplement
• Page Start: 201
• Page End: 202
• Publication Date: 2014-08-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/01.neu.0000452403.15403.b3
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: The treatment of unruptured very small intracranial aneurysms (UVSIAs), defined as less than or equal to 3 mm, can be indicated in rare circumstances. Recent publications have examined the feasibility and outcomes of endovascular therapy for UVSIAs. However, the efficacy and complication rate related to surgical clipping of UVSIAs has not been well defined in any large series to date. Therefore, we conducted a multicenter study to examine surgical outcomes for UVSIAs. METHODS: All consecutive patients undergoing surgery for an UVSIA in 4 neurosurgical centers between October 2001 and December 2012 were retrospectively analyzed. RESULTS: The study included 183 patients (128 women, 55 men) with a mean age of 51.3 years (21.2-78.0); a total of 228 aneurysms were treated with 190 procedures. Most were anterior circulation aneurysms (215 compared to 13 in the posterior circulation). The vast majority of aneurysms could be treated by direct clipping (222 aneurysms, 97.4%), with coagulation or wrapping used in the remaining few cases. After 1 reoperation for incomplete clipping, postoperative imaging confirmed complete occlusion in 221 aneurysms (96.9%), neck remnant in 1 case (0.44%), and partial occlusion in 3 patients (1.3%). Posterior circulation location was a significant risk factor for neurological deterioration in the early postoperative period compared to the anterior circulation, with new neurological deficits developing in 38.5% and 3.3% of cases, respectively ( P < .005). After 30 days, however, all deficits related to the treatment of posterior circulation aneurysms recovered. The neurological morbidity decreased to 2.7% with no mortality. CONCLUSION: The surgical clipping of UVSIAs is highly effective and is associated with a low morbidity rate. The low risk of rupture of small aneurysms nevertheless warrants a very selective approach in the decision to offer treatment.