Journal
CLINICAL NEUROLOGY AND NEUROSURGERY
Volume 113, Issue 2, Pages 129-135Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.clineuro.2010.10.012
Keywords
Aneurysm repair; Atherosclerotic; Intracerebral aneurysm; Surgical morbidity; Evoked potentials; Intraoperative monitoring; Morbidity
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Background: The incidence of ischemia might be increased in the surgical repair of atherosclerotic unruptured aneurysms compared to non-atherosclerotic aneurysms. The atherosclerotic wall might increase the occurrence of thrombembolic events or its rigidity might endanger the occlusion of perforators within the aneurysm vicinity. Methods: 87 patients (53 patients without and 34 patients with atherosclerotic unruptured aneurysms, 50.5 +/- 9.7 years) were analyzed for severity of atherosclerosis within the aneurysm and the aneurysm bearing vessel, surgical maneuvers, intraoperative alterations in evoked potentials and clinical and neuroradiological results. Results: Temporary vessel occlusion (25% vs. 50%, p = 0.021), repositioning of a permanent clip (21% vs. 56%, p = 0.001) and aneurysm remnants (2% vs. 18%, p = 0.012) occurred more often in patients with atherosclerotic aneurysms. At 6 months, 3/34 patients with atherosclerosis (8.8%) had an unfavorable outcome, all patients without atherosclerosis had a favorable outcome (p = 0.056). Conclusion: The surgical repair of unruptured aneurysms is safe but patients with atherosclerotic altered vessels and aneurysms accounted to a minor increase in unfavorable outcome and an increased risk of morbidity at 6 months postoperatively. This factor should be taken into consideration when performing surgery of atherosclerotic, unruptured aneurysms. (C) 2010 Elsevier B.V. All rights reserved.
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