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Journal of Neurosurgical Sciences 2018 Oct 10

DOI: 10.23736/S0390-5616.18.04430-2


language: English

The influence of clinical and radiological parameters in treatment of ruptured intracranial aneurysms: a single center 7-year retrospective cohort study

Arianna RUSTICI 1, Ciro PRINCIOTTA 1, Corrado ZENESINI 2, Carlo BORTOLOTTI 3, Carmelo STURIALE 3, Massimo DALL'OLIO 1, Marco LEONARDI 1, Luigi CIRILLO 1, 5

1 IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Bologna, Italy 2 IRCCS Istituto delle Scienze Neurologiche di Bologna, Servizio di Epidemiologia e Biostatistica, Bologna, Italy; 3 IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy; 4 Neuroradiologia, Alma Mater Studiorum Università di Bologna, Bologna, Italy; 5 Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Università di Bologna, Bologna, Italy


BACKGROUND: In many clinical trials endovascular procedures are suggested as the treatment of choice for aneurysmal Subarachnoid Hemorrhage (aSAH) whenever possible. However, in clinical practice this management is often controversial. The aim of this study is to analyze factors involved in this decision.
METHODS: Our study included 317 consecutive cases of aSAH between 2010 and 2016, assessing clinical and neuroradiological features to evaluate their role in this choice.
RESULTS: In our series coiling was preferred in 119 (37.6%) patients, while 198 (62.4%) were treated surgically. On univariate analysis location of aneurysms (p < 0.001), GCS score on admission (p: 0.105), degree of midline shift (p:0.015), Fisher’ score (p: 0.002) and presence of vessels in the aneurysmal neck (p: 0.071) proved the most relevant factors in the choice. Also multivariate analysis confirmed the location and Fisher’ grade as influential factors. Conversely, other radiological parameters, such as morphology, aspect and dome-neck ratio, presence of pre-operative vasospasm or hydrocephalus were not associated with this decision.
CONCLUSIONS: The decision process in aSAH requires a multidisciplinary team, to singularly evaluate each patient. We found that the location of aneurysms in Vertebro-Basilar circulation, PCoM and ICA, greater GCS score, absence of vessels in the aneurysmal neck, lower midline shift and Fisher’ score are factors influencing in choosing coiling. Conversely, morphology, Aspect and Dome-Neck ratio proved not relevant to this decision, due to technological improvement and increasing skills in the endovascular treatment.

KEY WORDS: Aneurysmal subarachnoid hemorrhage - Ruptured intracranial aneurysms - Endovascular treatment - Surgical clipping - Treatment decision - Coil embolization

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