Single Stage Operation for Multiple Cerebral Aneurysms of the Anterior Circulation
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Single Stage Operation for Multiple Cerebral Aneurysms of the Anterior Circulation

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Congressis 2012, Iasi - First Prize at Surgical Section

Also presented at: Medicalis Cluj-Napoca, Romania 2012; Leiden International Medical Students Conference 2013

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  • 1. Cristina Caterina Aldea1Alexandru Durutya2Ioan Ştefan Florian314thyear medical student 2Radiology Clinic Cluj-Napoca 3Neurosurgery Clinic Cluj-Napoca“Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
  • 2.  If a patient harbors multiple cerebralaneurysms, none of them can be deemedinoffensive1 Single stage operation with treatmentof all aneurysms is beneficial, sparing thepatient from sequential craniotomies andanesthesia Unilateral approach for bilateralaneurysms – uncertainty about outcomeBackgroundIntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusions1:T.Hong, Y. Wang : Unilateral Approach to Clip Bilateral Multiple Intracranial Aneurysms.Surgical Neurology 2009
  • 3. Clarify this uncertainty for the level of theNeurosurgery Department of the ClujCounty Emergency HospitalIntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusionsAim of study
  • 4.  Single center single surgeon retrospectivestudy 44 patients with a total of 117 aneurysms( October 1997- February 2012) 2 groups – Unilateral aneurysms of theAnterior Circulation / Bilateral aneurysmsof the Anterior Circulation Data was obtained from admission formsIntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusionsMaterials & Methods
  • 5.  Inclusion criteria: Hunt & Hess scale < 5 ASA score < 4 treated with:▪ unilateral fronto-pterional approach (on theside of the ruptured aneurysm)▪ clipping of all aneurysmsIntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusions
  • 6.  Analyzed data: Complication rate:▪ Hydrocephalus,Vasospasm, Re-bleeding▪ Infection, Subdural hemorrhage▪ Correlation with rupture site Mortality State at discharge (Glasgow OutcomeScale – GOS) Data analysis: EpiInfo statistical softwareIntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusions
  • 7.  OperativeTechnique:IntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusions
  • 8.  OperativeTechnique:IntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusions
  • 9.  OperativeTechnique:IntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusions
  • 10.  OperativeTechnique:IntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusionsEarly (first 96 hrsafter rupture)Late (more than 96 hrsafter rupture)
  • 11.  Number of aneurysms per patient: Male : Female ratio = 1:3IntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusionsResults
  • 12.  Localization: Most frequent combinations: ACoA – MCA andACoA – PCoA Mirror-like aneurysms: 6 casesIntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusions
  • 13. IntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusionsUnilateral or BilateralChi square value P valueHunt & Hess scale 0,07 0,7927ASA score 0,2995 0,5842Mortality 1,4125 0,2346Complications 0,0918 0,7619GOS 0,9219 0,337! 53% of patients discharged with GOS of 4 (moderatelydisabled) and 5 (good recovery)
  • 14. Site Ruptured Compl. Correlation p valueMCA 20 5 0,31 0,127ICA 6 2 0,46 0,183ACoA 14 8 0,69 0,042PCoA 2 0 0 -ACA 2 1 0,50 1,238IntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusionsCorrelation between rupture site andcomplication rate
  • 15.  There are no major differences betweenthe 2 groups regarding the rate ofcomplications or the outcome None of the rupture sites is correlatedwith an increased risk of developingcomplications ACoA had the highest correlation/statisticalsignificanceConclusionsIntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusions
  • 16.  If performed by a skilled neurosurgeon:fronto-pterional approach with clippingof all aneurysms, is beneficial for bothunilateral and bilateral multiple cerebralaneurysms of the anterior circulationIntroductionBackgroundAimMaterials and MethodsStudy DesignOperative techniqueResultsNumberLocalizationOutcomeConclusions