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Acta Neurochirurgica

, Volume 160, Issue 8, pp 1653–1660 | Cite as

Cranial nerve deficits in giant cavernous carotid aneurysms and their relation to aneurysm morphology and location

  • G. Durner
  • M. Piano
  • P. Lenga
  • D. Mielke
  • C. Hohaus
  • S. Guhl
  • N. Maldaner
  • J. K. Burkhardt
  • M. T. Pedro
  • J. Lehmberg
  • D. Rufenacht
  • P. Bijlenga
  • N. Etminan
  • J. K. Krauss
  • E. Boccardi
  • D. Hänggi
  • P. Vajkoczy
  • Julius Dengler
  • on behalf of the Giant Intracranial Aneurysm Study Group
Original Article - Vascular
  • 26 Downloads

Abstract

Background

Giant cavernous carotid aneurysms (GCCAs) usually exert substantial mass effect on adjacent intracavernous cranial nerves. Since predictors of cranial nerve deficits (CNDs) in patients with GCCA are unknown, we designed a study to identify associations between CND and GCCA morphology and the location of mass effect.

Methods

This study was based on data from the prospective clinical and imaging databases of the Giant Intracranial Aneurysm Registry. We used magnetic resonance imaging and digital subtraction angiography to examine GCCA volume, presence of partial thrombosis (PT), GCCA origins, and the location of mass effect. We also documented whether CND was present.

Results

We included 36 GCCA in 34 patients, which had been entered into the registry by eight participating centers between January 2009 and March 2016. The prevalence of CND was 69.4%, with one CND in 41.7% and more than one in 27.5%. The prevalence of PT was 33.3%. The aneurysm origin was most frequently located at the anterior genu (52.8%). The prevalence of CND did not differ between aneurysm origins (p = 0.29). Intracavernous mass effect was lateral in 58.3%, mixed medial/lateral in 27.8%, and purely medial in 13.9%. CND occurred significantly more often in GCCA with lateral (81.0%) or mixed medial/lateral (70.0%) mass effect than in GCCA with medial mass effect (20.0%; p = 0.03). After adjusting our data for the effects of the location of mass effect, we found no association between the prevalence of CND and aneurysm volume (odds ratio (OR) 1.30 (0.98–1.71); p = 0.07), the occurrence of PT (OR 0.64 (0.07–5.73); p = 0.69), or patient age (OR 1.02 (95% CI 0.95–1.09); p = 0.59).

Conclusions

Distinguishing between medial versus lateral location of mass effect may be more helpful than measuring aneurysm volumes or examining aneurysm thrombosis in understanding why some patients with GCCA present with CND while others do not.

Clinical trial registration no.

NCT02066493 (clinicaltrials.gov)

Keywords

Giant intracranial aneurysms Cavernous carotid aneurysm Aneurysm volume Partial thrombosis 

Notes

Acknowledgements

The authors would like to thank all members of the Giant Intracranial Aneurysm Group.

Funding

The Giant Intracranial Aneurysm Registry is funded by the Center for Stroke Research-Berlin (Grant No. CS-2009-12) to JD, the coordinating officer of the registry. The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Dr. Nima Etminan is a member of Medical monitor and steering committee NEWTON 2 and received Research grant PROTECT-U, which are unrelated to the present study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • G. Durner
    • 1
  • M. Piano
    • 2
  • P. Lenga
    • 3
  • D. Mielke
    • 4
  • C. Hohaus
    • 5
  • S. Guhl
    • 6
  • N. Maldaner
    • 7
  • J. K. Burkhardt
    • 7
  • M. T. Pedro
    • 1
  • J. Lehmberg
    • 8
  • D. Rufenacht
    • 9
  • P. Bijlenga
    • 10
  • N. Etminan
    • 11
  • J. K. Krauss
    • 12
  • E. Boccardi
    • 2
  • D. Hänggi
    • 11
  • P. Vajkoczy
    • 3
  • Julius Dengler
    • 3
  • on behalf of the Giant Intracranial Aneurysm Study Group
  1. 1.Department of Neurosurgery, Bezirkskrankenhaus GünzburgUniversity of UlmGünzburgGermany
  2. 2.Department of NeuroradiologyMetropolitan Hospital NiguardaMilanItaly
  3. 3.Department of NeurosurgeryCharité-Universitaetsmedizin BerlinBerlinGermany
  4. 4.Department of NeurosurgeryGeorg-August-University GoettingenGoettingenGermany
  5. 5.Department of NeurosurgeryBG-Clinic BergmannstrostHalleGermany
  6. 6.Department of NeurosurgeryUniversity of GreifswaldGreifswaldGermany
  7. 7.Department of NeurosurgeryUniversity Hospital of ZurichZurichSwitzerland
  8. 8.Department of NeurosurgeryTechnical University of MunichMunichGermany
  9. 9.Department of NeuroradiologyClinic HirslandenZurichSwitzerland
  10. 10.Department of NeurosurgeryUniversity Hospital GenevaGenevaSwitzerland
  11. 11.Department of NeurosurgeryUniversity Hospital MannheimMannheimGermany
  12. 12.Department of NeurosurgeryHannover Medical SchoolHannoverGermany

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