Anosmia after endovascular and open surgical treatment of intracranial aneurysms

Clinical article

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Object

Patients treated for aneurysmal subarachnoid hemorrhage (SAH) often report a loss of smell. To discriminate between the effects of aneurysmal rupture and treatment, the authors assessed the occurrence of anosmia after clipping and coiling of unruptured aneurysms as well as after the coiling of ruptured aneurysms.

Methods

The authors interviewed patients in whom an unruptured aneurysm was treated by clipping (32 cases) or endovascular coiling (26 cases) as well as patients with SAH who underwent coil therapy (32 cases). A geographically defined subset of 20 patients per group was invited to undergo olfactory testing.

Results

Nine clip-treated patients (28% [95% CI 14–47%]) in the unruptured group reported having anosmia, and no coil-treated patient in the unruptured group (95% [CI 0–13%]) reported having anosmia; in the SAH group, 7 patients (22% [95% CI 9–40%]) reported having anosmia. Anosmia had improved over time in 3 of the clip-treated patients and in all but 1 of the patients with SAH. Examination revealed olfactory disturbance in 13 (65% [95% CI 41–85%]) of the clip-treated and 8 (42% [95% CI 20–67%]) of the coil-treated patients with unruptured aneurysms, and also in 7 (35% [95% CI 15–59%]) coil-treated patients with SAH. In 20 patients who underwent clip therapy for unruptured aneurysms, 19 (95% [95% CI 75–100%]) had olfactory dysfunction on the side ipsilateral to surgery (anosmia reported by 8 of them).

Conclusions

Both clip treatment and SAH contribute to the occurrence of anosmia, with different chances of improvement. Olfactory dysfunction occurs in almost all patients on the side of surgery and can occur subclinically after coil deployment.

Abbreviation used in this paper: SAH = subarachnoid hemorrhage.

Article Information

Address correspondence to: Bon H. Verweij, M.D., Department of Neurosurgery, G03.124 University Medical Center Utrecht, Heidelberglaan 100, 3484 CX Utrecht, The Netherlands. email: B.H.Verweij@umcutrecht.nl.

© AANS, except where prohibited by US copyright law.

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References

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