Surgical and Endovascular Treatment in a One-year Serie of Patients with Aneurysmatic Lesions - Lugano 2013

• Published in: Journal of Neurological Surgery Part A: Central European Neurosurgery
• Main Authors: Valsecchi, D., Reinert, M. M.
• Format: Conference Proceeding
• Language: English
• Published: 11.06.2014
• ISSN: 2193-6315; 2193-6323
• DOI: 10.1055/s-0034-1383808

Aims : During the Year 2013 we took in charge at our Hospital in Lugano 21 patients suffering by aneurysmatic lesions, with SAH or in elective surgery. We evaluate retrospectively the outcome between patients who underwent DSA and who didn’t. Furthermore, we evaluated correlation between aneurysm size and location and outcome. Methods : We collected retrospectively all the data about the patients treated in 2013, suffering by aneurysmatic lesions. We then compared patients who underwent endovascular diagnostic or treating procedures, with those patients who didn’t. We compared then outcome at the discharge from the Intensive Care Unit, according to the mRanking. In those patients who had worst outcome, we evaluate a correlation between the greatest diameter of the aneurysm and the negative outcome, using MIP sequences on the angio-CT scan. Discussion : In 2013, we took in charge 21 patients, who suffered by aneurysmatic lesions, whose 15 had acute stroke with SAH and 6 no ruptured aneurysms. In 19 cases (89%) we were able to perform a treatment. Patients with good clinical presentation at the onset (WFNS I-II), had better outcome, with mRanking 1 in 89% at the discharge. In patients with WFNS >II, the outcome was at contrary with exitus in 75% of the cases. Localization of the aneurysms showed that the most common lesions were on the left MCA (M1-M2), by which suffered the 33% of patients. Lesions with worst outcome had been those on the ACoA, detected on 14% of patients only, but with exitus in 66% of cases. Preoperative Digital Suppressed Angiography (DSA) was performed in 53% of patients. In the remaining 47% of cases, we performed surgical treatment with just angio-CT scan. The mRanking 1 was the result in 55% of patients who underwent DSA, while patients who didn't had good outcome in 50% of cases. About outcome in treated patients, good outcome was achieved in 75% of patients with coiling and 45% in those who underwent craniotomy. Finally, 78% of patients with poor outcome (mRanking >3) had aneurysms with the greatest diameter >15 mm, whose 100% the patients who died (also those who didn’t receive any treatment). Conclusion : There wasn’t a great difference in good outcome between patients who underwent preoperative DSA and those who didn't (55% vs. 50%). Patients treated in endovascular way had a great benefit, with 75% of mRanking 1 at discharge. Patients with poor outcome had greater diameter of the aneurysm (75% >15 mm), or ACoA aneurysms (exitus in 66%).