Microsurgical clipping of unruptured anterior circulation aneurysms – a global multicenter investigation of perioperative outcomes

Jennifer Sauvigny; Richard Drexler; Tobias F Pantel; Franz L Ricklefs; Joshua Catapano; John Wanebo; Michael Lawton; Aiminaa Sanchin; Nils Hecht; Peter Vajkoczy; Kunal Raygor; Daniel Tonetti; Adib Abla; Kareem El Naamani; Stavropoula Tjoumakaris; Pascal Jabbour; Brian T. Jankowitz; Mohamed Salem; JK Burkhardt; Arthur Wagner; M Wostrack; Jens Gempt; Bernhard Meyer; Michael Gaub; Justin Mascitelli; Philippe Dodier; Gerhard Bavinzski; Karl Rössler; Nico Stroh; Matthias Gmeiner; Andreas Gruber; et al.

doi:10.1227/neu.0000000000002829

Microsurgical clipping of unruptured anterior circulation aneurysms – a global multicenter investigation of perioperative outcomes

Jennifer Sauvigny
, Richard Drexler
, Tobias F Pantel
, Franz L Ricklefs
, Joshua Catapano
, John Wanebo
, Michael Lawton
, Aiminaa Sanchin
, Nils Hecht
, Peter Vajkoczy
, Kunal Raygor
, Daniel Tonetti
, Adib Abla
, Kareem El Naamani
, Stavropoula Tjoumakaris
, Pascal Jabbour
, Brian T. Jankowitz
, Mohamed Salem
, JK Burkhardt
, Arthur Wagner

M Wostrack, Jens Gempt, Bernhard Meyer, Michael Gaub, Justin Mascitelli, Philippe Dodier, Gerhard Bavinzski, Karl Rössler, Nico Stroh, Matthias Gmeiner, Andreas Gruber, et al.

Department of Neurosurgery

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND AND OBJECTIVES: Microsurgical aneurysm repair by clipping continues to be highly important despite increasing endovascular treatment options, especially because of inferior occlusion rates. This study aimed to present current global microsurgical treatment practices and to identify risk factors for complications and neurological deterioration after clipping of unruptured anterior circulation aneurysms.

METHODS: Fifteen centers from 4 continents participated in this retrospective cohort study. Consecutive patients who underwent elective microsurgical clipping of untreated unruptured intracranial aneurysm between January 2016 and December 2020 were included. Posterior circulation aneurysms were excluded. Outcome parameters were postsurgical complications and neurological deterioration (defined as decline on the modified Rankin Scale) at discharge and during follow-up. Multivariate regression analyses were performed adjusting for all described patient characteristics.

RESULTS: Among a total of 2192 patients with anterior circulation aneurysm, complete occlusion of the treated aneurysm was achieved in 2089 (95.3%) patients at discharge. The occlusion rate remained stable (94.7%) during follow-up. Regression analysis identified hypertension (P < .02), aneurysm diameter (P < .001), neck diameter (P < .05), calcification (P < .01), and morphology (P = .002) as preexisting risk factors for postsurgical complications and neurological deterioration at discharge. Furthermore, intraoperative aneurysm rupture (odds ratio 2.863 [CI 1.606-5.104]; P < .01) and simultaneous clipping of more than 1 aneurysm (odds ratio 1.738 [CI 1.186-2.545]; P < .01) were shown to be associated with an increased risk of postsurgical complications. Yet, none of the surgical-related parameters had an impact on neurological deterioration. Analyzing volume-outcome relationship revealed comparable complication rates (P = .61) among all 15 participating centers.

CONCLUSION: Our international, multicenter analysis presents current microsurgical treatment practices in patients with anterior circulation aneurysms and identifies preexisting and surgery-related risk factors for postoperative complications and neurological deterioration. These findings may assist in decision-making for the optimal therapeutic regimen of unruptured anterior circulation aneurysms.

Original language	English
Pages (from-to)	1218-1226
Number of pages	9
Journal	Neurosurgery
Volume	94
Issue number	6
DOIs	https://doi.org/10.1227/neu.0000000000002829
Publication status	Published - 01 Jun 2024

Fields of science

302051 Neurosurgery

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10.1227/neu.0000000000002829

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Sauvigny, J., Drexler, R., Pantel, T. F., Ricklefs, F. L., Catapano, J., Wanebo, J., Lawton, M., Sanchin, A., Hecht, N., Vajkoczy, P., Raygor, K., Tonetti, D., Abla, A., El Naamani, K., Tjoumakaris, S., Jabbour, P., Jankowitz, B. T., Salem, M., Burkhardt, JK., ... et al. (2024). Microsurgical clipping of unruptured anterior circulation aneurysms – a global multicenter investigation of perioperative outcomes. Neurosurgery, 94(6), 1218-1226. https://doi.org/10.1227/neu.0000000000002829

@article{566838a2875240ae8596586a047f8002,

title = "Microsurgical clipping of unruptured anterior circulation aneurysms – a global multicenter investigation of perioperative outcomes",

abstract = "BACKGROUND AND OBJECTIVES: Microsurgical aneurysm repair by clipping continues to be highly important despite increasing endovascular treatment options, especially because of inferior occlusion rates. This study aimed to present current global microsurgical treatment practices and to identify risk factors for complications and neurological deterioration after clipping of unruptured anterior circulation aneurysms.METHODS: Fifteen centers from 4 continents participated in this retrospective cohort study. Consecutive patients who underwent elective microsurgical clipping of untreated unruptured intracranial aneurysm between January 2016 and December 2020 were included. Posterior circulation aneurysms were excluded. Outcome parameters were postsurgical complications and neurological deterioration (defined as decline on the modified Rankin Scale) at discharge and during follow-up. Multivariate regression analyses were performed adjusting for all described patient characteristics.RESULTS: Among a total of 2192 patients with anterior circulation aneurysm, complete occlusion of the treated aneurysm was achieved in 2089 (95.3\%) patients at discharge. The occlusion rate remained stable (94.7\%) during follow-up. Regression analysis identified hypertension (P < .02), aneurysm diameter (P < .001), neck diameter (P < .05), calcification (P < .01), and morphology (P = .002) as preexisting risk factors for postsurgical complications and neurological deterioration at discharge. Furthermore, intraoperative aneurysm rupture (odds ratio 2.863 [CI 1.606-5.104]; P < .01) and simultaneous clipping of more than 1 aneurysm (odds ratio 1.738 [CI 1.186-2.545]; P < .01) were shown to be associated with an increased risk of postsurgical complications. Yet, none of the surgical-related parameters had an impact on neurological deterioration. Analyzing volume-outcome relationship revealed comparable complication rates (P = .61) among all 15 participating centers.CONCLUSION: Our international, multicenter analysis presents current microsurgical treatment practices in patients with anterior circulation aneurysms and identifies preexisting and surgery-related risk factors for postoperative complications and neurological deterioration. These findings may assist in decision-making for the optimal therapeutic regimen of unruptured anterior circulation aneurysms.",

author = "Jennifer Sauvigny and Richard Drexler and Pantel, \{Tobias F\} and Ricklefs, \{Franz L\} and Joshua Catapano and John Wanebo and Michael Lawton and Aiminaa Sanchin and Nils Hecht and Peter Vajkoczy and Kunal Raygor and Daniel Tonetti and Adib Abla and \{El Naamani\}, Kareem and Stavropoula Tjoumakaris and Pascal Jabbour and Jankowitz, \{Brian T.\} and Mohamed Salem and JK Burkhardt and Arthur Wagner and M Wostrack and Jens Gempt and Bernhard Meyer and Michael Gaub and Justin Mascitelli and Philippe Dodier and Gerhard Bavinzski and Karl R{\"o}ssler and Nico Stroh and Matthias Gmeiner and Andreas Gruber and \{et al.\}",

year = "2024",

month = jun,

day = "1",

doi = "10.1227/neu.0000000000002829",

language = "English",

volume = "94",

pages = "1218--1226",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Wolters Kluwer",

number = "6",

}

Sauvigny, J, Drexler, R, Pantel, TF, Ricklefs, FL, Catapano, J, Wanebo, J, Lawton, M, Sanchin, A, Hecht, N, Vajkoczy, P, Raygor, K, Tonetti, D, Abla, A, El Naamani, K, Tjoumakaris, S, Jabbour, P, Jankowitz, BT, Salem, M, Burkhardt, JK, Wagner, A, Wostrack, M, Gempt, J, Meyer, B, Gaub, M, Mascitelli, J, Dodier, P, Bavinzski, G, Rössler, K, Stroh, N , Gmeiner, M , Gruber, A & et al. 2024, 'Microsurgical clipping of unruptured anterior circulation aneurysms – a global multicenter investigation of perioperative outcomes', Neurosurgery, vol. 94, no. 6, pp. 1218-1226. https://doi.org/10.1227/neu.0000000000002829

TY - JOUR

T1 - Microsurgical clipping of unruptured anterior circulation aneurysms – a global multicenter investigation of perioperative outcomes

AU - Sauvigny, Jennifer

AU - Drexler, Richard

AU - Pantel, Tobias F

AU - Ricklefs, Franz L

AU - Catapano, Joshua

AU - Wanebo, John

AU - Lawton, Michael

AU - Sanchin, Aiminaa

AU - Hecht, Nils

AU - Vajkoczy, Peter

AU - Raygor, Kunal

AU - Tonetti, Daniel

AU - Abla, Adib

AU - El Naamani, Kareem

AU - Tjoumakaris, Stavropoula

AU - Jabbour, Pascal

AU - Jankowitz, Brian T.

AU - Salem, Mohamed

AU - Burkhardt, JK

AU - Wagner, Arthur

AU - Wostrack, M

AU - Gempt, Jens

AU - Meyer, Bernhard

AU - Gaub, Michael

AU - Mascitelli, Justin

AU - Dodier, Philippe

AU - Bavinzski, Gerhard

AU - Rössler, Karl

AU - Stroh, Nico

AU - Gmeiner, Matthias

AU - Gruber, Andreas

AU - et al., null

PY - 2024/6/1

Y1 - 2024/6/1

N2 - BACKGROUND AND OBJECTIVES: Microsurgical aneurysm repair by clipping continues to be highly important despite increasing endovascular treatment options, especially because of inferior occlusion rates. This study aimed to present current global microsurgical treatment practices and to identify risk factors for complications and neurological deterioration after clipping of unruptured anterior circulation aneurysms.METHODS: Fifteen centers from 4 continents participated in this retrospective cohort study. Consecutive patients who underwent elective microsurgical clipping of untreated unruptured intracranial aneurysm between January 2016 and December 2020 were included. Posterior circulation aneurysms were excluded. Outcome parameters were postsurgical complications and neurological deterioration (defined as decline on the modified Rankin Scale) at discharge and during follow-up. Multivariate regression analyses were performed adjusting for all described patient characteristics.RESULTS: Among a total of 2192 patients with anterior circulation aneurysm, complete occlusion of the treated aneurysm was achieved in 2089 (95.3%) patients at discharge. The occlusion rate remained stable (94.7%) during follow-up. Regression analysis identified hypertension (P < .02), aneurysm diameter (P < .001), neck diameter (P < .05), calcification (P < .01), and morphology (P = .002) as preexisting risk factors for postsurgical complications and neurological deterioration at discharge. Furthermore, intraoperative aneurysm rupture (odds ratio 2.863 [CI 1.606-5.104]; P < .01) and simultaneous clipping of more than 1 aneurysm (odds ratio 1.738 [CI 1.186-2.545]; P < .01) were shown to be associated with an increased risk of postsurgical complications. Yet, none of the surgical-related parameters had an impact on neurological deterioration. Analyzing volume-outcome relationship revealed comparable complication rates (P = .61) among all 15 participating centers.CONCLUSION: Our international, multicenter analysis presents current microsurgical treatment practices in patients with anterior circulation aneurysms and identifies preexisting and surgery-related risk factors for postoperative complications and neurological deterioration. These findings may assist in decision-making for the optimal therapeutic regimen of unruptured anterior circulation aneurysms.

AB - BACKGROUND AND OBJECTIVES: Microsurgical aneurysm repair by clipping continues to be highly important despite increasing endovascular treatment options, especially because of inferior occlusion rates. This study aimed to present current global microsurgical treatment practices and to identify risk factors for complications and neurological deterioration after clipping of unruptured anterior circulation aneurysms.METHODS: Fifteen centers from 4 continents participated in this retrospective cohort study. Consecutive patients who underwent elective microsurgical clipping of untreated unruptured intracranial aneurysm between January 2016 and December 2020 were included. Posterior circulation aneurysms were excluded. Outcome parameters were postsurgical complications and neurological deterioration (defined as decline on the modified Rankin Scale) at discharge and during follow-up. Multivariate regression analyses were performed adjusting for all described patient characteristics.RESULTS: Among a total of 2192 patients with anterior circulation aneurysm, complete occlusion of the treated aneurysm was achieved in 2089 (95.3%) patients at discharge. The occlusion rate remained stable (94.7%) during follow-up. Regression analysis identified hypertension (P < .02), aneurysm diameter (P < .001), neck diameter (P < .05), calcification (P < .01), and morphology (P = .002) as preexisting risk factors for postsurgical complications and neurological deterioration at discharge. Furthermore, intraoperative aneurysm rupture (odds ratio 2.863 [CI 1.606-5.104]; P < .01) and simultaneous clipping of more than 1 aneurysm (odds ratio 1.738 [CI 1.186-2.545]; P < .01) were shown to be associated with an increased risk of postsurgical complications. Yet, none of the surgical-related parameters had an impact on neurological deterioration. Analyzing volume-outcome relationship revealed comparable complication rates (P = .61) among all 15 participating centers.CONCLUSION: Our international, multicenter analysis presents current microsurgical treatment practices in patients with anterior circulation aneurysms and identifies preexisting and surgery-related risk factors for postoperative complications and neurological deterioration. These findings may assist in decision-making for the optimal therapeutic regimen of unruptured anterior circulation aneurysms.

UR - https://www.scopus.com/pages/publications/105014920523

U2 - 10.1227/neu.0000000000002829

DO - 10.1227/neu.0000000000002829

M3 - Article

C2 - 38240568

SN - 0148-396X

VL - 94

SP - 1218

EP - 1226

JO - Neurosurgery

JF - Neurosurgery

IS - 6

ER -

Microsurgical clipping of unruptured anterior circulation aneurysms – a global multicenter investigation of perioperative outcomes

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