TY - JOUR
T1 - Open Microsurgical Cerebral Aneurysm Treatment After Failed Endovascular Therapy
T2 - An Evaluation of Aneurysm Treatment Frequencies in All Neurovascular Centers Across Austria and the Czech Republic Over 20 Years
AU - Griessenauer, Christoph J.
AU - Dodier, Philippe
AU - Stroh, Nico H.
AU - Mercea, Petra A.
AU - Bavinzski, Gerhard
AU - Dorfer, Christian
AU - Roessler, Karl
AU - Gruber, Andreas
AU - Gmeiner, Matthias
AU - Thome, Claudius
AU - Leber, Klaus A.
AU - Wolfsberger, Stefan
AU - Baghban, Mustafa
AU - Al-Schameri, Rahman
AU - Kral, Michael
AU - Thakur, Som
AU - Lunzer, Manuel
AU - Popadic, Branko
AU - Sherif, Camillo
AU - Juran, Vilem
AU - Smrcka, Martin
AU - Netuka, David
AU - Steklacova, Anna
AU - Lipina, Radim
AU - Hrbac, Tomas
AU - Vecera, Zdenek
AU - Fiedler, Jiri
AU - Grubhoffer, Marek
AU - Hrabalek, Lumir
AU - Krahulik, David
AU - Koller, Lukas
AU - Kretschmer, Thomas
AU - Priban, Vladimir
AU - Mracek, Jan
AU - Sames, Martin
AU - Hejcl, Ales
AU - Klener, Jan
AU - Sroubek, Jan
AU - Petr, Ondra
N1 - Griessenauer, Mercea, Kral, Thakur, Lunzer: Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
PY - 2024/12
Y1 - 2024/12
N2 - BACKGROUND AND OBJECTIVES:Endovascular treatment of cerebral aneurysms has tremendously advanced over the past decades. Nevertheless, aneurysm residual and recurrence remain challenges after embolization. The objective of this study was to elucidate the portion of embolized aneurysms requiring open surgery and evaluate whether newer endovascular treatments have changed the need for open surgery after failed embolization.METHODS:All 15 cerebrovascular centers in Austria and the Czech Republic provided overall aneurysm treatment frequency data and retrospectively reviewed consecutive cerebral aneurysms treated with open surgical treatment after failure of embolization from 2000 to 2022. All endovascular modalities were included.RESULTS:On average, 1362 aneurysms were treated annually in the 2 countries. The incidence increased from 0.006% in 2005 to 0.008% in 2020 in the overall population. Open surgery after failed endovascular intervention was necessary in 128 aneurysms (0.8%), a proportion that remained constant over time. Subarachnoid hemorrhage was the initial presentation in 70.3% of aneurysms. The most common location was the anterior communicating artery region (40.6%), followed by the middle cerebral artery (25.0%). The median diameter was 6 mm (2-32). Initial endovascular treatment included coiling (107 aneurysms), balloon-assist (10), stent-assist (4), intrasaccular device (3), flow diversion (2), and others (2). Complete occlusion after initial embolization was recorded in 40.6%. Seventy-one percent of aneurysms were operated within 3 years after embolization. In 7%, the indication for surgery was (re-)rupture and, in 88.3%, reperfusion. Device removal was performed in 16.4%. Symptomatic intraoperative and postoperative complications occurred in 10.2%. Complete aneurysm occlusion after open surgery was achieved in 94%.CONCLUSION:Open surgery remains a rare indication for cerebral aneurysms after failed endovascular embolization even in the age of novel endovascular technology, such as flow diverters and intrasaccular devices. Regardless, it is mostly performed for ruptured aneurysms initially treated with primary coiling that are in the anterior circulation.
AB - BACKGROUND AND OBJECTIVES:Endovascular treatment of cerebral aneurysms has tremendously advanced over the past decades. Nevertheless, aneurysm residual and recurrence remain challenges after embolization. The objective of this study was to elucidate the portion of embolized aneurysms requiring open surgery and evaluate whether newer endovascular treatments have changed the need for open surgery after failed embolization.METHODS:All 15 cerebrovascular centers in Austria and the Czech Republic provided overall aneurysm treatment frequency data and retrospectively reviewed consecutive cerebral aneurysms treated with open surgical treatment after failure of embolization from 2000 to 2022. All endovascular modalities were included.RESULTS:On average, 1362 aneurysms were treated annually in the 2 countries. The incidence increased from 0.006% in 2005 to 0.008% in 2020 in the overall population. Open surgery after failed endovascular intervention was necessary in 128 aneurysms (0.8%), a proportion that remained constant over time. Subarachnoid hemorrhage was the initial presentation in 70.3% of aneurysms. The most common location was the anterior communicating artery region (40.6%), followed by the middle cerebral artery (25.0%). The median diameter was 6 mm (2-32). Initial endovascular treatment included coiling (107 aneurysms), balloon-assist (10), stent-assist (4), intrasaccular device (3), flow diversion (2), and others (2). Complete occlusion after initial embolization was recorded in 40.6%. Seventy-one percent of aneurysms were operated within 3 years after embolization. In 7%, the indication for surgery was (re-)rupture and, in 88.3%, reperfusion. Device removal was performed in 16.4%. Symptomatic intraoperative and postoperative complications occurred in 10.2%. Complete aneurysm occlusion after open surgery was achieved in 94%.CONCLUSION:Open surgery remains a rare indication for cerebral aneurysms after failed endovascular embolization even in the age of novel endovascular technology, such as flow diverters and intrasaccular devices. Regardless, it is mostly performed for ruptured aneurysms initially treated with primary coiling that are in the anterior circulation.
KW - Epidemiology
KW - Failed endovascular therapy
KW - Open microvascular surgery
KW - Ruptured aneurysms
KW - Unruptered aneuryms
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=pmu_pure&SrcAuth=WosAPI&KeyUT=WOS:001374324200010&DestLinkType=FullRecord&DestApp=WOS_CPL
U2 - 10.1227/neu.0000000000003040
DO - 10.1227/neu.0000000000003040
M3 - Original Article
C2 - 38864626
SN - 0148-396X
VL - 95
SP - 1349
EP - 1357
JO - NEUROSURGERY
JF - NEUROSURGERY
IS - 6
ER -