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Factors Affecting on the Prognosis in Multiple Intracranial Aneurysms

Year 2020, Volume: 17 Issue: 3, 475 - 481, 25.12.2020

Abstract

Background: With improvements in diagnostic methods, the incidence of multiple intracranial aneurysms has increased up to 35%. Factors influential on outcome in multiple intracranial aneurysms are still debatable. We aimed to determine risk factors related to multiple intracranial aneurysms in patients admitted with subarachnoid hemorrhage caused by a ruptured intracranial aneurysm.
Material and Methods: This retrospective study was performed on 105 aneurysms of 48 patients diagnosed with multiple aneurysms using charts, records, and film archives among 250 patients admitted to İstanbul Haydarpaşa Numune Training and Research Hospital between January 2003-December 2009 who were examined and treated for subarachnoid hemorrhage. Age, gender, medical history, admission/surgery times, clinical features determined on neurological examination at admission (WFNS Score), amount of blood measured on cranial computed tomographic images (Fisher Score), number of aneurysms and systems to which they belonged, complications, and Glasgow outcome scale indicating the morbidity and mortality were recorded.
Results: The mean age was 52.75±14.02(4-90) years. The female/male ratio was 2.2. Most common clinical features were headache (83.7%), and hypertension (56.3%). The most common location was the middle cerebral artery, and aneurysm size was 2-6 mm (66.7%). The most common intervention was an early clipping of as many aneurysms as possible in one session (84.7%). Vasospasm and hydrocephalus were the most common complications (31.1%, 16.6%, respectively). No difference was present between early and late interventions regarding mortality. Glasgow outcome Scale was negatively correlated with Fisher score (r=-0.306), but not with WFNS score.
Conclusions: Age, amount of cisternal blood preoperatively, and postoperative vasospasm are risk factors for mortality, but not hypertension and postoperative hydrocephalus. WFNS Scoring system is not a reliable mortality predictor.

Key Words: Multiple intracranial aneurysms, Fisher score, Glasgow outcome scale, Subarachnoid hemorrhage, WFNS Score

References

  • 1. Ellamushi HE, Grieve JP, Jager HR, Kitchen ND. Risk factors for the formation of multiple intracranial aneurysms. J Neurosurg. 2001;94(5):728-32.
  • 2. Rinne J, Hernesniemi J, Puranen M, Saari T. Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery. 1994;35(5):803-8.
  • 3. Jabbarli R, Dinger TF, Darkwah Oppong M, Pierscianek D, Dammann P, Wrede KH, et al. Risk Factors for and Clinical Consequences of Multiple Intracranial Aneurysms: A Systematic Review and Meta-Analysis. Stroke. 2018;49(4):848-55.
  • 4. Kassell NF, Torner JC, Jane JA, Haley EC, Jr., Adams HP. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg. 1990;73(1):37-47.
  • 5. Mizoi K, Suzuki J, Yoshimoto T. Surgical treatment of multiple aneurysms. Review of experience with 372 cases. Acta Neurochir (Wien). 1989;96(1-2):8-14.
  • 6. Rinne J, Hernesniemi J, Niskanen M, Vapalahti M. Management outcome for multiple intracranial aneurysms. Neurosurgery. 1995;36(1):31-7; discussion 7-8.
  • 7. Yaşargil MG. Multiple Aneurysms. In: Yaşargil MG, editor. Microneurosurgery: II Clinical Considerations, Surgery of the intracranial aneurysms and results. 2. Stuttgart: George Thieme Verlag; 1984. p. 305-28.
  • 8. Yaşargil MG. Pathological Considerations. In: Yaşargil MG, editor. Microneurosurgery: I Microsurgical Anatomy of the Basal Cisterns and Vessels of the Brain; Diagnostic Studies, General Operative Techniques and Pathological Considerations of the Intracranial Aneurysms. 1. Stuttgart: George Thieme Verlag; 1984. p. 279-349.
  • 9. Juvela S. Risk factors for multiple intracranial aneurysms. Stroke. 2000;31(2):392-7.
  • 10. Inagawa T. Multiple intracranial aneurysms in elderly patients. Acta Neurochir (Wien). 1990;106(3-4):119-26.
  • 11. Kaminogo M, Yonekura M, Shibata S. Incidence and outcome of multiple intracranial aneurysms in a defined population. Stroke. 2003;34(1):16-21.
  • 12. Wachter D, Kreitschmann-Andermahr I, Gilsbach JM, Rohde V. Early surgery of multiple versus single aneurysms after subarachnoid hemorrhage: an increased risk for cerebral vasospasm? J Neurosurg. 2011;114(4):935-41.
  • 13. Oh K, Lim YC. Single-session Coil Embolization of Multiple Intracranial Aneurysms. J Cerebrovasc Endovasc Neurosurg. 2013;15(3):184-90.
  • 14. Defillo A, Qureshi M, Nussbaum ES. Are Multiple Intracranial Aneurysms, More Than 5 At One Time, Almost Exclusively A Female Disease? A Clinical Series and Literature Review. J Neurol Stroke. 2014;1(4).
  • 15. Inagawa T. Surgical treatment of multiple intracranial aneurysms. Acta Neurochir (Wien). 1991;108(1-2):22-9.
  • 16. Nehls DG, Flom RA, Carter LP, Spetzler RF. Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg. 1985;63(3):342-8.
  • 17. Fogelholm R, Hernesniemi J, Vapalahti M. Impact of early surgery on outcome after aneurysmal subarachnoid hemorrhage. A population-based study. Stroke. 1993;24(11):1649-54.
  • 18. Wang R, Zhang D, Zhao J, Wang S, Zhao Y, Niu H. A comparative study of 43 patients with mirror-like intracranial aneurysms: risk factors, treatment, and prognosis. Neuropsychiatr Dis Treat. 2014;10:2231-7.
  • 19. Kassell NF, Torner JC, Haley EC, Jr., Jane JA, Adams HP, Kongable GL. The International Cooperative Study on the Timing of Aneurysms Surgery. Part I: Overall management results. J Neurosurg. 1990;73:18-37.
  • 20. Schievink WI. Genetics of intracranial aneurysms. Neurosurgery. 1997;40(4):651-62; discussion 62-3.
  • 21. Jiang H, Weng YX, Zhu Y, Shen J, Pan JW, Zhan RY. Patient and aneurysm characteristics associated with rupture risk of multiple intracranial aneurysms in the anterior circulation system. Acta Neurochir (Wien). 2016;158(7):1367-75.
  • 22. Sheehan JP, Polin RS, Sheehan JM, Baskaya MK, Kassell NF. Factors associated with hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery. 1999;45(5):1120-7; discussion 7-8.
  • 23. Tomlinson BE. Ischaemic lesions of the cerebral hemispheres following rupture of intracranial aneurysms. 1. Descriptions of the ischaemic lesions. Newcastle Med J. 1966;29:81-4.
  • 24. Solomon RA, Onesti ST, Klebanoff L. Relationship between the timing of aneurysm surgery and the development of delayed cerebral ischemia. J Neurosurg. 1991;75(1):56-61.
  • 25. Inagawa T. Effect of early operation on cerebral vasospasm. Surg Neurol. 1990;33(4):239-46.
  • 26. Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007;38(8):2315-21.
  • 27. Weyhenmeyer J, Guandique CF, Leibold A, Lehnert S, Parish J, Han W, et al. Effects of distance and transport method on intervention and mortality in aneurysmal subarachnoid hemorrhage. J Neurosurg. 2018;128(2):490-8.
  • 28. Lanzino G, Kassell NF, Germanson TP, Kongable GL, Truskowski LL, Torner JC, et al. Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse? J Neurosurg. 1996;85(3):410-8.
  • 29. Tapaninaho A, Hernesniemi J, Vapalahti M, Niskanen M, Kari A, Luukkonen M, et al. Shunt-dependent hydrocephalus after subarachnoid haemorrhage and aneurysm surgery: timing of surgery is not a risk factor. Acta Neurochir (Wien). 1993;123(3-4):118-24.
  • 30. Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6(1):1-9.
  • 31. Harrod CG, Bendok BR, Batjer HH. Prediction of cerebral vasospasm in patients presenting with aneurysmal subarachnoid hemorrhage: a review. Neurosurgery. 2005;56(4):633-54; discussion -54.

Çoklu İntrakraniyal Anevrizmalarda Prognozda Etkili Faktörler

Year 2020, Volume: 17 Issue: 3, 475 - 481, 25.12.2020

Abstract

Amaç: Tanı yöntemlerindeki gelişmelerin sonucunda, multipl intrakraniyal anevrizma insidansı %35'e kadar yükselmiştir. Multipl intrakraniyal anevrizmalarda prognoz üzerinde etkili olan faktörler halen tartışmalıdır. Bu çalışmada, rüptüre olmuş intrakraniyal anevrizmanın neden olduğu subaraknoid kanama ile başvuran hastalarda MİA prognozu ile ilişkili faktörleri belirlemeyi amaçladık.
Materyal ve Metod: Bu retrospektif çalışma, Ocak 2003-Aralık 2009 tarihleri arasında İstanbul Haydarpaşa Numune Eğitim ve Araştırma Hastanesi’nde subaraknoid kanama nedeni ve anevrizma tanısı ile tetkik ve tedavi edilen 250 olgu arasında hasta çizelgeleri, kayıtları ve film arşivleri değerlendirilerek multipl anevrizma kriterlerine uyan 48 olgunun 105 anevrizması üzerinde gerçekleştirildi. Yaş, cinsiyet, tıbbi öykü, başvuru / cerrahi süreleri, başvurudaki nörolojik muayene bulgu değerlendirmesindeki özellikler (WFNS skoru), bilgisayarlı beyin tomografi görüntülerde ölçülen kan miktarı (Fisher Skoru), anevrizma sayısı ve ait oldukları sistemler, komplikasyonlar, morbidite ve mortaliteyi gösteren Glasgow sonuç skalası kaydedildi.
Bulgular: Yaş ortalaması 52,75 ± 14,02 (4-90) yıldı. Kadın / erkek oranı 2.2 idi. En sık görülen klinik özellikler baş ağrısı (% 83.7) ve hipertansiyon (% 56.3) olarak bulundu. En sık yerleşim yeri orta serebral arterdi ve anevrizma boyutu 2-6 mm (% 66.7) idi. En sık yapılan girişim tek seansta mümkün olduğunca çok anevrizmanın erken kliplenmesiydi (% 84.7). Vazospazm ve hidrosefali en sık görülen komplikasyonlardı (sırasıyla % 31.1 ve % 16.6). Erken ve geç girişim zamanları arasında mortalite açısından fark bulunmadı. Glasgow sonuç skalası skoru ile Fisher skorunun negatif korelasyonu olduğu bulundu (r = -0.306), ancak WFNS evresi ile korelasyon mevcut değildi.
Sonuç: Yaş, preoperatif sisternal kan miktarı ve postoperatif vazospazm mortalite için risk faktörleri olarak bulundu. Ancak hipertansiyon ve postoperatif hidrosefali risk faktörü değildi. WFNS skorlama sisteminin güvenilir bir mortalite belirleyicisi olmadığı sonucuna varıldı.

Anahtar Kelimeler: Çoklu intrakraniyal anevrizma, Fisher skoru, Glasgow sonuç skala, Subaraknoid kanama, WFNS evresi

References

  • 1. Ellamushi HE, Grieve JP, Jager HR, Kitchen ND. Risk factors for the formation of multiple intracranial aneurysms. J Neurosurg. 2001;94(5):728-32.
  • 2. Rinne J, Hernesniemi J, Puranen M, Saari T. Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery. 1994;35(5):803-8.
  • 3. Jabbarli R, Dinger TF, Darkwah Oppong M, Pierscianek D, Dammann P, Wrede KH, et al. Risk Factors for and Clinical Consequences of Multiple Intracranial Aneurysms: A Systematic Review and Meta-Analysis. Stroke. 2018;49(4):848-55.
  • 4. Kassell NF, Torner JC, Jane JA, Haley EC, Jr., Adams HP. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg. 1990;73(1):37-47.
  • 5. Mizoi K, Suzuki J, Yoshimoto T. Surgical treatment of multiple aneurysms. Review of experience with 372 cases. Acta Neurochir (Wien). 1989;96(1-2):8-14.
  • 6. Rinne J, Hernesniemi J, Niskanen M, Vapalahti M. Management outcome for multiple intracranial aneurysms. Neurosurgery. 1995;36(1):31-7; discussion 7-8.
  • 7. Yaşargil MG. Multiple Aneurysms. In: Yaşargil MG, editor. Microneurosurgery: II Clinical Considerations, Surgery of the intracranial aneurysms and results. 2. Stuttgart: George Thieme Verlag; 1984. p. 305-28.
  • 8. Yaşargil MG. Pathological Considerations. In: Yaşargil MG, editor. Microneurosurgery: I Microsurgical Anatomy of the Basal Cisterns and Vessels of the Brain; Diagnostic Studies, General Operative Techniques and Pathological Considerations of the Intracranial Aneurysms. 1. Stuttgart: George Thieme Verlag; 1984. p. 279-349.
  • 9. Juvela S. Risk factors for multiple intracranial aneurysms. Stroke. 2000;31(2):392-7.
  • 10. Inagawa T. Multiple intracranial aneurysms in elderly patients. Acta Neurochir (Wien). 1990;106(3-4):119-26.
  • 11. Kaminogo M, Yonekura M, Shibata S. Incidence and outcome of multiple intracranial aneurysms in a defined population. Stroke. 2003;34(1):16-21.
  • 12. Wachter D, Kreitschmann-Andermahr I, Gilsbach JM, Rohde V. Early surgery of multiple versus single aneurysms after subarachnoid hemorrhage: an increased risk for cerebral vasospasm? J Neurosurg. 2011;114(4):935-41.
  • 13. Oh K, Lim YC. Single-session Coil Embolization of Multiple Intracranial Aneurysms. J Cerebrovasc Endovasc Neurosurg. 2013;15(3):184-90.
  • 14. Defillo A, Qureshi M, Nussbaum ES. Are Multiple Intracranial Aneurysms, More Than 5 At One Time, Almost Exclusively A Female Disease? A Clinical Series and Literature Review. J Neurol Stroke. 2014;1(4).
  • 15. Inagawa T. Surgical treatment of multiple intracranial aneurysms. Acta Neurochir (Wien). 1991;108(1-2):22-9.
  • 16. Nehls DG, Flom RA, Carter LP, Spetzler RF. Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg. 1985;63(3):342-8.
  • 17. Fogelholm R, Hernesniemi J, Vapalahti M. Impact of early surgery on outcome after aneurysmal subarachnoid hemorrhage. A population-based study. Stroke. 1993;24(11):1649-54.
  • 18. Wang R, Zhang D, Zhao J, Wang S, Zhao Y, Niu H. A comparative study of 43 patients with mirror-like intracranial aneurysms: risk factors, treatment, and prognosis. Neuropsychiatr Dis Treat. 2014;10:2231-7.
  • 19. Kassell NF, Torner JC, Haley EC, Jr., Jane JA, Adams HP, Kongable GL. The International Cooperative Study on the Timing of Aneurysms Surgery. Part I: Overall management results. J Neurosurg. 1990;73:18-37.
  • 20. Schievink WI. Genetics of intracranial aneurysms. Neurosurgery. 1997;40(4):651-62; discussion 62-3.
  • 21. Jiang H, Weng YX, Zhu Y, Shen J, Pan JW, Zhan RY. Patient and aneurysm characteristics associated with rupture risk of multiple intracranial aneurysms in the anterior circulation system. Acta Neurochir (Wien). 2016;158(7):1367-75.
  • 22. Sheehan JP, Polin RS, Sheehan JM, Baskaya MK, Kassell NF. Factors associated with hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery. 1999;45(5):1120-7; discussion 7-8.
  • 23. Tomlinson BE. Ischaemic lesions of the cerebral hemispheres following rupture of intracranial aneurysms. 1. Descriptions of the ischaemic lesions. Newcastle Med J. 1966;29:81-4.
  • 24. Solomon RA, Onesti ST, Klebanoff L. Relationship between the timing of aneurysm surgery and the development of delayed cerebral ischemia. J Neurosurg. 1991;75(1):56-61.
  • 25. Inagawa T. Effect of early operation on cerebral vasospasm. Surg Neurol. 1990;33(4):239-46.
  • 26. Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007;38(8):2315-21.
  • 27. Weyhenmeyer J, Guandique CF, Leibold A, Lehnert S, Parish J, Han W, et al. Effects of distance and transport method on intervention and mortality in aneurysmal subarachnoid hemorrhage. J Neurosurg. 2018;128(2):490-8.
  • 28. Lanzino G, Kassell NF, Germanson TP, Kongable GL, Truskowski LL, Torner JC, et al. Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse? J Neurosurg. 1996;85(3):410-8.
  • 29. Tapaninaho A, Hernesniemi J, Vapalahti M, Niskanen M, Kari A, Luukkonen M, et al. Shunt-dependent hydrocephalus after subarachnoid haemorrhage and aneurysm surgery: timing of surgery is not a risk factor. Acta Neurochir (Wien). 1993;123(3-4):118-24.
  • 30. Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6(1):1-9.
  • 31. Harrod CG, Bendok BR, Batjer HH. Prediction of cerebral vasospasm in patients presenting with aneurysmal subarachnoid hemorrhage: a review. Neurosurgery. 2005;56(4):633-54; discussion -54.
There are 31 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Tezcan Çalışkan 0000-0001-7735-0584

Mehmet Sabri Gürbüz

Mehmet Onur Yüksel 0000-0003-0922-4249

Mehmet Zafer Berkman 0000-0001-9946-0362

Publication Date December 25, 2020
Submission Date October 6, 2020
Acceptance Date December 18, 2020
Published in Issue Year 2020 Volume: 17 Issue: 3

Cite

Vancouver Çalışkan T, Gürbüz MS, Yüksel MO, Berkman MZ. Factors Affecting on the Prognosis in Multiple Intracranial Aneurysms. Harran Üniversitesi Tıp Fakültesi Dergisi. 2020;17(3):475-81.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty