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. 2024 Jan 19;94(6):1218-1226.
doi: 10.1227/neu.0000000000002829. Online ahead of print.

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

Jennifer Sauvigny  1 , Richard Drexler  1 , Tobias F Pantel  1 , Franz L Ricklefs  1 , Joshua S Catapano  2 , John E Wanebo  2 , Michael T Lawton  2 , Aminaa Sanchin  3 , Nils Hecht  3 , Peter Vajkoczy  3 , Kunal Raygor  4 , Daniel Tonetti  4 , Adib Abla  4 , Kareem El Naamani  5 , Stavropoula I Tjoumakaris  5 , Pascal Jabbour  5 , Brian T Jankowitz  6 , Mohamed M Salem  6 , Jan-Karl Burkhardt  6 , Arthur Wagner  7 , Maria Wostrack  7 , Jens Gempt  1   7 , Bernhard Meyer  7 , Michael Gaub  8 , Justin R Mascitelli  8 , Philippe Dodier  9 , Gerhard Bavinzski  9 , Karl Roessler  9 , Nico Stroh  10 , Matthias Gmeiner  10 , Andreas Gruber  10 , Eberval G Figueiredo  11 , Antonio Carlos Samaia da Silva Coelho  11 , Anatoliy V Bervitskiy  12 , Egor D Anisimov  12 , Jamil A Rzaev  12 , Harald Krenzlin  13 , Naureen Keric  13 , Florian Ringel  13 , Dougho Park  14 , Mun-Chul Kim  14 , Eleonora Marcati  15 , Marco Cenzato  15 , Linda Krause  16 , Manfred Westphal  1 , Lasse Dührsen  1 , Thomas Sauvigny  1
Affiliations

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

Jennifer Sauvigny et al. Neurosurgery. .

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.

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Figures

FIGURE.
FIGURE.
Total number of procedures performed per center during the study period. Color coded represents the proportion of aneurysms with respect to their localization.
None
See this image and copyright information in PMC

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