The endovascular treatment outcomes in the surgery of asymptomatic unruptured aneurysms of anterior circulation

Objective. To estimate the endovascular treatment outcomes in the surgery of asymptomatic unruptured intradural aneurysms of anterior circulation of the circle of Willis. Material and methods. Retrospective analysis of 92 patients with unruptured aneurysms of the anterior part of the circle of Willis treated at Burdenko Institute of Neurosurgery in the period from 2000 to 2011 was performed; patients’ age varied from 12 to 73 years. Multiple aneurysms were discovered at 11 patients. Endovascular embolization by coils was performed at all cases, 35 patients also underwent stent and balloon assistance. Results and discussion. The following clinical outcomes have been observed: absence of neurological deficits in 86 (93.5%), permanent neurological deficits in 5 (5.4%) cases; intraoperative ruptures were seen in 3 patients, thromboembolism - 3 patients. Mortality was 1,1%. Complete occlusion was achieved in 70 (76.05%) cases, subtotal in 19 (20,65%) and partial occlusion in 3 (3.3%) cases. During follow up period (from 1 till 11 years) including 52 patients the complete aneurysm occlusion was maintained in 95% of cases. None of the treated patients with subtotal and partial occlusions suffered from intracranial hemorrhage during the follow-up period. Conclusion. The endovascular treatment by skilled surgeons could be the treatment choice for random intradural aneurysms of the anterior circle of Willis.

интрадуральные аневризмы, неразорвавшиеся аневризмы, эндоваскулярное лечение, intradural aneurysms, unruptured aneurysms, endovascular treatment

1. Хейреддин А.С., Филатов Ю.М, Элиава Ш.Ш, Золотухин С.П, Сазонов И.А., Белоусова О.Б, Торботряс Н.Л. Хирургическое лечение асимптомных неразорвавшихся интракраниальных аневризм. Вопросы нейрохирургии 2004г стр 2-7

2. Bederson J.B., Awad I.A., Wiebers D.O., Piepgras D., Haley E.C. Jr, Brott T., Hademenos G., Chyatte D., Rosenwasser R., Caroselli C. Recommendations for the management of patients with unruptured brain aneurysms and arteriovenous malformations 1415 aneurysms: A Statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke. 2000;31:2742-2750.

3. Caranci F., Briganti F., Cirillo L., Leonardi M., Muto M. Epidemiology and genetics of intracranial aneurysms. Eur J Radiol. 2013 Oct;82(10):1598-60.

4. Etminan N., Beseoglu K., Barrow D.L., Bederson J., Brown R.D. et al. Multidisciplinary Consensus on Assessment of Unruptured Intracranial Aneurysms. Proposal of an International Research Group. Stroke. Published online March 25, 2014.

5. Feigin V.L., Rinkel G.J., Lawes C.M. et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke 2005;36: 2773-80.

6. Ferns S.P, Sprengers M.E., vanRooij W.J., Rinkel G.J., vanRijn J.C., Bipat S., Sluzewski M., and Majoie C.B. Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke, 2009; 40: e523-e529.

7. Iwamoto H., Kiyohara Y., Fujishima M., Kato I., Nakayama K., Sueishi K., Tsuneyoshi M. Prevalence of intracranial saccular aneurysms inajapanese community based on a consecutive autopsy series duringa 30-year observation period. The hisayama study. Stroke 1999; 30, 1390-1395.

8. Jeon T.Y, Jeon P., Kim K.H. Prevalence of Unruptured Intracranial Aneurysm on MR Angiography. Korean J Radiol 2011; 12(5): 547-553.

9. Juvela S., Porras M., Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J.Neurosurg. 2008 May; 108(5): 1052-60.

10. McDonald J.S., McDonald R.J., Fan J., Kalmess D.F., Lanzino G., Cloft H.J. Comparative effectiveness of unruptured cerebral aneurysm therapies. Propensity score Analysis of Clipping Versus Coiling. Stroke 2013;44:988-994

11. Menghini V.V., Brown R.D. Jr, Sicks J.D., O'Fallon W. M., and Wiebers D.O. Incidence and prevalence of intracranial aneurysms and hemorrhage in Olmsted county, Minnesota, 1965 to 1995. Neurology 1998;51, 405-411

12. Raymond J., Meder J.F., Molyneux A.J., Fox A.J., Johnston S.C., Collet J.P., Rouleau A. The Trial On Endovascular Aneurysm Management Team Collaborative Group. Unruptured intracranial aneurysms: the unreliability of clinical judgment, the necessity for evidence, and reasons to participate in a randomized trial. J Neuroradiol. 2006;4:211 219

13. Rinkel G.J., Djibuti M., Algra A., and vanGijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematicreview. Stroke 1998; 29, 251-25.

14. Sanai N., Tarapore P., Lee A.C., Lawton M.T. The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular era. Neurosurgery. 2008 Jun 62(6):1236-49

15. Vlak M.H., Rinkel G.J., Greebe P., van der Bom J.G., Algra A. Trigger factors for rupture of intracranial aneurysms in relation to patient and aneurysm characteristics. J Neurol. 2012; Jul;259(7):1298-302

16. Wiebers D.O., Whisnant J.P., Huston J., Meissner I., Brown R.D. Jr, Piepgras D.G, Forbes G.S., Thielen K., Nichols D., O’Fallon W.M., Peacock J., Jaeger L., Kassell N.F., Kongabl Beckman G.L., Torner J.C. International Study of Unruptured Intracranial Aneurysm Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362: 103-110.

17. Winn H.R., Jane J.A.Sr, Taylor J., Kaiser D., and Britz G.W. Prevalence of asymptomatic incidental aneurysms: review of 4568 arteriograms. J. Neurosurg. 2002; 96, 43-49.