Impact of aneurysm shape and neck configuration on cerebral infarction during microsurgical clipping of intracranial aneurysms

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  • 1 Center for Neurosurgery and
  • 2 Department of Neuroradiology, University Hospital of Cologne, Germany

OBJECTIVE

Cerebral infarction is a significant cause of morbidity and mortality related to microsurgical clipping of intracranial aneurysms. The objective of this study was to determine the impact of aneurysm shape and neck configuration on cerebral infarction after aneurysm surgery.

METHODS

The authors retrospectively reviewed consecutive cases of ruptured and unruptured aneurysms treated with microsurgical clipping at their institution between 2010 and 2018. Three-dimensional reconstructions from preoperative computed tomography and digital subtraction angiography were used to determine aneurysm shape (regular/complex) and neck configuration (regular/irregular). Morphological and procedure-related risk factors for cerebral infarction were identified using univariate and multivariate statistical analyses.

RESULTS

Among 243 patients with 252 aneurysms (148 ruptured, 104 unruptured), the overall cerebral infarction rate was 17.1%. Infarction tended to occur more often in aneurysms with complex shape (p = 0.084). Likewise, aneurysms with an irregular neck had a significantly higher rate of infarction (37.5%) than aneurysms with regular neck configuration (10.1%, p < 0.001). Aneurysms with an irregular neck were associated with a higher rate of intraoperative rupture (p = 0.003) and temporary parent artery occlusion (p = 0.037). In the multivariate analysis, irregular neck configuration was identified as an independent risk factor for infarction (OR 4.2, 95% CI 1.9–9.4, p < 0.001), whereas the association between aneurysm shape and infarction was not significant (p = 0.966).

CONCLUSIONS

Irregular aneurysm neck configuration represents an independent risk factor for cerebral infarction during microsurgical clipping of both ruptured and unruptured aneurysms.

ABBREVIATIONS CTA = computed tomography angiography; D = dome; DSA = digital subtraction angiography; H = height; IR = irregular; ISUIA = International Study of Unruptured Intracranial Aneurysms; Lob = lobulated; mRS = modified Rankin Scale; MSA = aneurysm with multiple sacs; N = neck; R = regular; ROC = receiver operating characteristic; SAH = subarachnoid hemorrhage; W = width; WFNS = World Federation of Neurosurgical Societies.

Contributor Notes

Correspondence Lukas Goertz: Center for Neurosurgery, University Hospital of Cologne, Germany. lukas.goertz@uk-koeln.de.

INCLUDE WHEN CITING Published online April 12, 2019; DOI: 10.3171/2019.1.JNS183193.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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