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Comparison of carotid and basilar bifurcation aneurysms versus non-T-angled bifurcations: the geometry is associated with the outcome

  • N. BrawanskiEmail author
  • M. Bruder
  • S. Y. Won
  • S. Tritt
  • J. Berkefeld
  • C. Senft
  • V. Seifert
  • J. Konczalla
ORIGINAL ARTICLE
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Abstract

Patients with ruptured aneurysms of carotid bifurcation artery seem to suffer less often from cerebral vasospasm and early brain injury and have a better clinical outcome. Aim of our study was to identify differences in clinical course and outcome in aneurysms of terminus segments (carotid bifurcation artery and basilar tip) compared to aneurysms of other aneurysm locations except carotid bifurcation artery and basilar tip. Patients with SAH were entered into a prospectively collected database (1999 to June 2014). A total of 471 patients (‘T-shaped’ aneurysms n = 63, ‘non-T-shaped’ aneurysms n = 408) were selected. Outcome was assessed by modified Rankin Scale (mRS) 6 months after SAH. Mean age was 53.75 years. Statistically, analysis showed a significant better outcome in ‘T-shaped’ aneurysms (p = 0.0001) and a significant lower mortality rate (p = 0.02) despite higher rates of Fisher 3 bleeding pattern and CVS. In ‘T-shaped’ aneurysms, no prognostic factors for outcome could be detected. In ‘non-T-shaped’ aneurysms admission status (p < 0.0001), early hydrocephalus (p < 0.0001), shunt-dependence (p = 0.001), and the occurrence of severe CVS (p = 0.01) statistically were factors influencing patients’ outcome. Multivariate analysis showed ‘non-T-shaped’ aneurysms itself as independent prognostic factor for patients’ outcome. Despite same rate of poor admission status, early hydrocephalus and shunt dependence ‘T-shaped’ aneurysms have a highly significantly better. Pathophysiological mechanism actually is not understood. Further studies are necessary to identify, which factors lead to the decreased outcome in “non-T-shaped”- aneurysms.

Keywords

Aneurysm location Outcome Prognostic factor Subarachnoid hemorrhage Geometry of carotid and basilar bifurcation aneurysms ‘T-shaped’ aneurysms ‘non-T-shaped’ aneurysms 

Notes

Compliance with ethical standards

Conflict of interest

JB: Consulting fee or honorarium: proctor for WEB, Sequent Medical and member of the scientific advisory board of Acandis. There is a permanent scientific cooperation between Siemens Healthcare AG and the Institute of Neuroradiology and travel expenses for presentation of projects are covered by the company. The other authors have no personal, financial, or institutional interest. All other authors declare that they have no competing interests.

Ethical approval

Approval for the retrospective study was obtained from the local ethic committee.

Informed consent

For this type of study (retrospective study) formal consent is not required.

Supplementary material

10143_2018_1056_MOESM1_ESM.docx (14 kb)
Suppl. Table 1 Comparison of outcome in carotid- T- and basilar tip- aneurysms (DOCX 13 kb)

References

  1. 1.
    Abla AA, Wilson DA, Williamson RW, Nakaji P, McDougall CG, Zabramski JM, Albuquerque FC, Spetzler RF (2014) The relationship between ruptured aneurysm location, subarachnoid hemorrhage clot thickness, and incidence of radiographic or symptomatic vasospasm in patients enrolled in a prospective randomized controlled trial. J Neurosurg 120:391–397.  https://doi.org/10.3171/2013.10.JNS13419 CrossRefGoogle Scholar
  2. 2.
    Ingebrigtsen T, Morgan MK, Faulder K, Ingebrigtsen L, Sparr T, Schirmer H (2004) Bifurcation geometry and the presence of cerebral artery aneurysms. J Neurosurg 101:108–113.  https://doi.org/10.3171/jns.2004.101.1.0108 CrossRefGoogle Scholar
  3. 3.
    Lilla N, Berger H, Sonnewald U, Hill D, Wideroe M, Ernestus R.-I WT (2017) Acute changes in brain metabolism in the early phase following experimental subarachnoid hemorrhage (SAH). In: Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint meeting mit der Society of British neurological surgeons (SBNS). MagdeburgGoogle Scholar
  4. 4.
    Konczalla J, Platz J, Brawanski N, Güresir E, Lescher S, Senft C, du Mesnil de Rochemont R, Berkefeld J, Seifert V (2015) Endovascular and surgical treatment of internal carotid bifurcation aneurysms. Neurosurgery 76:540–551.  https://doi.org/10.1227/NEU.0000000000000672 CrossRefGoogle Scholar
  5. 5.
    Platz J, Güresir E, Wagner M, Seifert V, Konczalla J (2016) Increased risk of delayed cerebral ischemia in subarachnoid hemorrhage patients with additional intracerebral hematoma. J Neurosurg:1–7.  https://doi.org/10.3171/2015.12.JNS151563
  6. 6.
    Westermaier T, Jauss A, Eriskat J, Kunze E, Roosen K (2009) Acute vasoconstriction: decrease and recovery of cerebral blood flow after various intensities of experimental subarachnoid hemorrhage in rats. J Neurosurg 110:996–1002.  https://doi.org/10.3171/2008.8.JNS08591 CrossRefGoogle Scholar
  7. 7.
    Sabri M, Lass E, Macdonald RL (2013) Early brain injury: a common mechanism in subarachnoid hemorrhage and global cerebral ischemia. Stroke Res Treat 2013:394036.  https://doi.org/10.1155/2013/394036 Google Scholar
  8. 8.
    Walmsley JG (1983) Vascular smooth muscle orientation in curved branches and bifurcations of human cerebral arteries. J Microsc 131:377–389CrossRefGoogle Scholar
  9. 9.
    Walmsley JG (1983) Vascular smooth muscle orientation in straight portions of human cerebral arteries. J Microsc 131:361–375CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of NeurosurgeryGoethe-University HospitalFrankfurt am MainGermany
  2. 2.Institute of NeuroradiologyGoethe- University HospitalFrankfurt am MainGermany
  3. 3.Institute of NeuroradiologyHelios HSK WiesbadenWiesbadenGermany

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