Intracranial aneurysm case series

176 patients with IA recruited in the Service of Neurosurgery at the University Hospital of Valladolid (Spain) and a control group if 150 sex-matched healthy subjects. Clinical variables were collected from each patient. We have analyzed VEGFA rs833061, VEGFR2 rs2071559, endothelin rs5370, endoglin rs3739817, and eNOS rs1799983 polymorphisms.

Results: Our results showed that allele T of the eNOS rs1799983 polymorphism is correlated with decreased risk of developing the disease; thus, allele G of the eNOS rs1799983 polymorphism increased the risk of developing IA.

Conclusion: The association of eNOS rs1799983 polymorphism with the risk to suffer IA reinforces the hypothesis that genetic variants in eNOS gene could be crucial in the pathogenesis of IA 1)

In the Cangzhou Central Hospital, a total of 144 patients with intracranial aneurysms were enrolled as the test subjects, who were randomly and evenly divided into the Intracranial Clipping group and the Interventional Embolization group. Cognitive and neurologic functions were evaluated by the Glasgow Outcome Scale, Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) scales, and National Institutes of Health Stroke Scale (NIHSS) and Activities of Daily Living (ADL) scale. Enzyme-linked immunosorbent assay was used to analyze the serum levels of neuron-specific enolase (NSE) and S100β.

There were no significant differences in the preoperative MMSE, MoCA, NIHSS, or ADL scale between the two groups (p > 0.05). However, after the operation, the MMSE and MoCA scores of the interventional embolization group were significantly higher, whereas the NIHSS and ADL scales were significantly lower than those of the intracranial clipping group (p < 0.05). The levels of NSE and S100β in the intracranial clipping group were significantly higher than in the interventional embolization group.

Intracranial aneurysm embolization exerts better effects on cognitive and neurologic functions than intracranial aneurysm clipping 2).

over the past 20 years, a total of 2032 aneurysms were treated. In 1263 endovascularly managed aneurysms the regrowth or incomplete initial occlusion necessitated 159 repeated procedures (12.6%). In the surgical group, a total of 27 aneurysms needed retreatment (3.5%). The difference is statistically significant. In nine patients in the endovascular group, the rebleeding was the reason for repeated procedures. No rebleeding was seen in the surgical group. This fact, also shown in the review part of the article, is important in patient counseling. Given the similar clinical results of both modalities, the patient should be advised on the necessity of repeated follow-ups and of possible technical failure and eventually repeated procedure which is more likely if an endovascular procedure is chosen 3).

compared two groups of patients (non-elderly, < 65 years; elderly, ≥ 65 years) who underwent surgical clipping or endovascular coiling and were registered in a nationwide database in Japan from 2010 through 2015. The odds ratio (OR) and 95% confidence interval (CI) of each risk factor were calculated through multivariate logistic regression analysis for poor outcome according to a modified Rankin Scale (mRS) score >2 at discharge for each group.

In all groups, the risk factors for poor outcome were older age, male sex, neurological grade on admission, diabetes mellitus, and use of anticoagulation drugs. Inverse risk factors were a high-volume hospital, academic hospital, hypertension, and use of an antiplatelet drug (OR 0.63-0.81: 95%CI 0.56-0.88). Chronic heart disease was also a risk factor, but use of a statin drug (0.85-0,87: 0.76-0.97) and location on the anterior communicating artery (0.74-0.80: 0.67-0.91) were inverse risks in both elderly and endovascular coiling groups.

Management for patients with aSAH was recommended in high-volume and academic institutes with the administration of antiplatelet drugs and consideration of several risk factors. Elderly patients undergoing endovascular coiling might be better given a statin drug, and patients with chronic heart failure or an anterior communicating artery aneurysm should be better treated more carefully 4).

In a retrospective review, Yeon et al. examined 299 patients with 339 aneurysms, all shown to be completely occluded at 36 months on follow-up images obtained between 2011 and 2013. Medical records and radiological data acquired during the extended monitoring period (mean 74.3 ± 22.5 months) were retrieved, and the authors analyzed the incidence of (including mean annual risk) and risk factors for delayed recanalization.

A total of 5 coiled aneurysms (1.5%) occluded completely at 36 months showed recanalization (0.46% per aneurysm-year) during the long-term surveillance period (1081.9 aneurysm-years), 2 surfacing within 60 months and 3 developing thereafter. Four showed minor recanalization, with only one instance of major recanalization. The latter involved the posterior communicating artery as an apparent de novo lesion, arising at the neck of a firmly coiled sac, and was unrelated to coil compaction or growth. Additional embolization was undertaken. In a multivariate analysis, a second embolization for a recurrent aneurysm (HR = 22.088, p = 0.003) independently correlated with delayed recanalization.

Almost all coiled aneurysms (98.5%) showing complete occlusion at 36 months postembolization proved to be stable during extended observation. However, recurrent aneurysms were predisposed to delayed recanalization. Given the low probability yet seriousness of delayed recanalization and the possibility of de novo aneurysm formation, careful monitoring may be still considered in this setting but at less frequent intervals beyond 36 months 5).

Of 818 patients undergoing Microsurgical Clipping of Intracranial Aneurysms who underwent cranial operations, 28 (3.4%) had a ventriculoperitoneal shunt. Four of these 28 (14.3%, 95% confidence interval [CI] 4.0%-32.7%) developed postoperative complications, compared to 42 of 790 (5.3%, 95% CI 4.0%-7.1%) without a history of VP shunt (P = .07). In addition, patients with a shunt were more likely to have longer cranial procedures (P = .04), longer hospital stays (P = .05), and more computed tomography scans during their craniotomy-associated admission (P = .002). Multivariate analysis, though not significant, demonstrated that the presence of a shunt contributed to the development of complications (odds ratio [OR] 2.24, 95% CI .70-7.13, P = .17). Length of surgery (OR 1.17, 95% CI 1.04-1.31, P = .01) and length of stay (OR 1.04, 95% CI 1.01-1.07, P = .01) were significantly longer in those with a postoperative complication.

Linzey et al. from Ann Arbor, found a nonsignificant trend toward increased postoperative complications in patients with a VP shunt who underwent a subsequent cranial operation 6).

A total of 53 patients from a single institution who initially presented with a subarachnoid hemorrhage and underwent surgical clipping of a previously coiled intracranial aneurysm between December 1997 and December 2014 were studied. Clinical features, hospital course, and preoperative and most recent functional status (Glasgow Outcome Scale score) were reviewed retrospectively.

The mean time interval from coiling to clipping was 2.6 years, and mean follow-up was 5.5 years (range, 0.1-14.7 years). Five patients (9.8%) presented with rebleed prior to clipping. Most patients (79.3%, 42/53) experienced good neurologic outcomes. Most showed no change (81%, 43/53) or improvement (13%, 7/53) in functional status after microsurgical clipping. One patient (2%) deteriorated clinically, and there were 2 mortalities (4%).

Microsurgical clipping of previously ruptured, coiled aneurysms is a promising treatment method with favorable clinical outcomes 7).

Usategui-Martín R, Jiménez-Arribas P, Sakas-Gandullo C, González-Sarmiento R, Rodríguez-Arias CA. Endothelial nitric oxide synthase rs1799983 gene polymorphism is associated with the risk of developing intracranial aneurysm. Acta Neurochir (Wien). 2023 Mar 18. doi: 10.1007/s00701-023-05552-3. Epub ahead of print. PMID: 36932233.
Gao P, Jin Z, Wang P, Zhang X. Effects of Intracranial Interventional Embolization and Intracranial Clipping on the Cognitive and Neurologic Function of Patients with Intracranial Aneurysms. Arch Clin Neuropsychol. 2022 May 22:acac030. doi: 10.1093/arclin/acac030. Epub ahead of print. PMID: 35596958.
Beneš V, Štekláčová A, Bradáč O. Repeated Aneurysm Intervention. Adv Tech Stand Neurosurg. 2022;44:277-296. doi: 10.1007/978-3-030-87649-4_16. PMID: 35107686.
Ikawa F, Michihata N, Iihara K, Akiyama Y, Morita A, Fushimi K, Yasunaga H, Kurisu K. Risk management of aneurysmal subarachnoid hemorrhage by age and treatment method from a nationwide database in Japan. World Neurosurg. 2019 Sep 12. pii: S1878-8750(19)32445-3. doi: 10.1016/j.wneu.2019.09.015. [Epub ahead of print] PubMed PMID: 31521760.
Yeon EK, Cho YD, Yoo DH, Lee SH, Kang HS, Kim JE, Cho WS, Choi HH, Han MH. Is 3 years adequate for tracking completely occluded coiled aneurysms? J Neurosurg. 2019 Aug 16:1-7. doi: 10.3171/2019.5.JNS183651. [Epub ahead of print] PubMed PMID: 31419789.
Linzey JR, Wilkinson DA, Nadel JL, Thompson BG, Pandey AS. Complications in Patients Undergoing Microsurgical Clipping of Intracranial Aneurysms with Pre-existing Ventriculoperitoneal Shunts Following a Cranial Procedure. J Stroke Cerebrovasc Dis. 2018 Dec 20. pii: S1052-3057(18)30686-4. doi: 10.1016/j.jstrokecerebrovasdis.2018.11.034. [Epub ahead of print] PubMed PMID: 30579731.
Nisson PL, Meybodi AT, Roussas A, James W, Berger GK, Benet A, Lawton MT. Surgical Clipping of Previously Ruptured, Coiled Aneurysms: Outcome Assessment in 53 Patients. World Neurosurg. 2018 Dec;120:e203-e211. doi: 10.1016/j.wneu.2018.07.293. Epub 2018 Aug 23. PubMed PMID: 30144619.
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