Acta Neurochir (2015) 157:13–20 DOI 10.1007/s00701-014-2251-1
CLINICAL ARTICLE - VASCULAR
Visual outcomes of endovascular and microsurgical treatment for large or giant paraclinoid aneurysms Tatsuya Shimizu & Isao Naito & Masanori Aihara & Hiroya Fujimaki & Ken Asakura & Naoko Miyamoto & Yuhei Yoshimoto
Received: 17 June 2014 / Accepted: 1 October 2014 / Published online: 19 October 2014 # Springer-Verlag Wien 2014
Abstract Background The optimal treatment for large or giant paraclinoid aneurysms is still controversial. The present study evaluated the results of endovascular coiling and microsurgical clipping with special reference to visual outcomes. Methods The clinical data and treatment outcomes of 39 cases of large (>15 mm) paraclinoid aneurysms were retrospectively reviewed. Presenting symptoms were subarachnoid hemorrhage in 16 aneurysms and visual impairment in 18. Twentyone aneurysms were treated by endovascular therapy and 18 were treated by direct surgery. Results Maximal aneurysm diameter ≥25 mm and preoperative visual acuity 15 mm) paraclinoid aneurysms in 36 consecutive patients treated in Gunma University, Geriatrics Research Institute and Hospital, and Maebashi Red Cross Hospital between January 2000 and December 2013. Clinical data were reviewed including patient age, sex, presenting symptoms, details of visual function (visual acuity, visual field, duration from symptom onset to treatment), angiographic features (maximal diameter, dome/neck ratio), treatment, and complications. This study was reviewed and approved by the institutional review board of Gunma University Graduate School of Medicine. Patient characteristics are shown in Table 1. The mean age of the patients at presentation was 55.3 years (range, 35–80 years). The mean maximal diameter of the aneurysm was 19.7 mm (range, 15–50 mm). Thirty-three aneurysms were large (15–25 mm) and six were giant (≥25 mm). The mean dome/neck ratio was 2.3±0.8 (± standard deviation). The clinical presentations were subarachnoid hemorrhage (SAH) in 16 cases, visual impairment in 18, and incidental discovery in five. Most patients presenting with SAH did not undergo preoperative examination of visual acuity. Although detailed information was not available, these patients were considered to have good preoperative visual acuity (≥20/100) in the absence of subjective visual symptoms prior to SAH. The duration from symptom onset to treatment ranged from 2 days to 6 years (mean, 19 months). The treatment modality was decided by discussion between the neurosurgical and endovascular teams, resulting in 21 aneurysms treated by endovascular therapy and 18 aneurysms treated by direct surgery. The morphological characteristic of the aneurysm is the primary determinant for the selection of treatment modality. However, decision-making should incorporate other factors such as patient age, clinical grade in SAH patients, and clinical symptoms (visual impairment). Direct surgery was the preferred treatment modality for patients with larger and/or wide neck aneurysms. Mean maximal diameters of the aneurysms treated by endovascular therapy and direct surgery were 18.8 mm and 20.7 mm, respectively, and mean dome/neck ratios were 2.4 and 2.1, respectively. Three recurrent aneurysms occurring after endovascular treatment in other institutions and two partially thrombosed giant aneurysms were
Acta Neurochir (2015) 157:13–20 Table 1 Patient characteristics No. of aneurysms Total Age, years
CLINICAL ARTICLE - VASCULAR
Visual outcomes of endovascular and microsurgical treatment for large or giant paraclinoid aneurysms Tatsuya Shimizu & Isao Naito & Masanori Aihara & Hiroya Fujimaki & Ken Asakura & Naoko Miyamoto & Yuhei Yoshimoto
Received: 17 June 2014 / Accepted: 1 October 2014 / Published online: 19 October 2014 # Springer-Verlag Wien 2014
Abstract Background The optimal treatment for large or giant paraclinoid aneurysms is still controversial. The present study evaluated the results of endovascular coiling and microsurgical clipping with special reference to visual outcomes. Methods The clinical data and treatment outcomes of 39 cases of large (>15 mm) paraclinoid aneurysms were retrospectively reviewed. Presenting symptoms were subarachnoid hemorrhage in 16 aneurysms and visual impairment in 18. Twentyone aneurysms were treated by endovascular therapy and 18 were treated by direct surgery. Results Maximal aneurysm diameter ≥25 mm and preoperative visual acuity 15 mm) paraclinoid aneurysms in 36 consecutive patients treated in Gunma University, Geriatrics Research Institute and Hospital, and Maebashi Red Cross Hospital between January 2000 and December 2013. Clinical data were reviewed including patient age, sex, presenting symptoms, details of visual function (visual acuity, visual field, duration from symptom onset to treatment), angiographic features (maximal diameter, dome/neck ratio), treatment, and complications. This study was reviewed and approved by the institutional review board of Gunma University Graduate School of Medicine. Patient characteristics are shown in Table 1. The mean age of the patients at presentation was 55.3 years (range, 35–80 years). The mean maximal diameter of the aneurysm was 19.7 mm (range, 15–50 mm). Thirty-three aneurysms were large (15–25 mm) and six were giant (≥25 mm). The mean dome/neck ratio was 2.3±0.8 (± standard deviation). The clinical presentations were subarachnoid hemorrhage (SAH) in 16 cases, visual impairment in 18, and incidental discovery in five. Most patients presenting with SAH did not undergo preoperative examination of visual acuity. Although detailed information was not available, these patients were considered to have good preoperative visual acuity (≥20/100) in the absence of subjective visual symptoms prior to SAH. The duration from symptom onset to treatment ranged from 2 days to 6 years (mean, 19 months). The treatment modality was decided by discussion between the neurosurgical and endovascular teams, resulting in 21 aneurysms treated by endovascular therapy and 18 aneurysms treated by direct surgery. The morphological characteristic of the aneurysm is the primary determinant for the selection of treatment modality. However, decision-making should incorporate other factors such as patient age, clinical grade in SAH patients, and clinical symptoms (visual impairment). Direct surgery was the preferred treatment modality for patients with larger and/or wide neck aneurysms. Mean maximal diameters of the aneurysms treated by endovascular therapy and direct surgery were 18.8 mm and 20.7 mm, respectively, and mean dome/neck ratios were 2.4 and 2.1, respectively. Three recurrent aneurysms occurring after endovascular treatment in other institutions and two partially thrombosed giant aneurysms were
Acta Neurochir (2015) 157:13–20 Table 1 Patient characteristics No. of aneurysms Total Age, years
