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 S Catapano; John E Wanebo; Michael T Lawton; Aminaa Sanchin; Nils Hecht; Peter Vajkoczy; Kunal Raygor; Daniel Tonetti; Adib Abla; Kareem El Naamani; Stavropoula I Tjoumakaris; Pascal Jabbour; Brian T Jankowitz; Mohamed M Salem; Jan-Karl Burkhardt; Arthur Wagner; Maria Wostrack; Jens Gempt; Bernhard Meyer; Michael Gaub; Justin R Mascitelli; Philippe Dodier; Gerhard Bavinzski; Karl Roessler; Nico Stroh; Matthias Gmeiner; Andreas Gruber; Eberval G Figueiredo; Antonio Carlos Samaia da Silva Coelho; Anatoliy V Bervitskiy; Egor D Anisimov; Jamil A Rzaev; Harald Krenzlin; Naureen Keric; Florian Ringel; Dougho Park; Mun-Chul Kim; Eleonora Marcati; Marco Cenzato; Linda Krause; Manfred Westphal; Lasse Dührsen; Thomas Sauvigny

doi:10.1227/neu.0000000000002829

Microsurgical Clipping of Unruptured Anterior Circulation Aneurysms-A Global Multicenter Investigation of Perioperative Outcomes

Neurosurgery. 2024 Jan 19;94(6):1218-1226. doi: 10.1227/neu.0000000000002829. Online ahead of print.

Authors

Jennifer Sauvigny¹, Richard Drexler¹, Tobias F Pantel¹, Franz L Ricklefs¹, Joshua S Catapano², John E Wanebo², Michael T Lawton², Aminaa Sanchin³, Nils Hecht³, Peter Vajkoczy³, Kunal Raygor⁴, Daniel Tonetti⁴, Adib Abla⁴, Kareem El Naamani⁵, Stavropoula I Tjoumakaris⁵, Pascal Jabbour⁵, Brian T Jankowitz⁶, Mohamed M Salem⁶, Jan-Karl Burkhardt⁶, Arthur Wagner⁷, Maria Wostrack⁷, Jens Gempt^{1

7}, Bernhard Meyer⁷, Michael Gaub⁸, Justin R Mascitelli⁸, Philippe Dodier⁹, Gerhard Bavinzski⁹, Karl Roessler⁹, Nico Stroh¹⁰, Matthias Gmeiner¹⁰, Andreas Gruber¹⁰, Eberval G Figueiredo¹¹, Antonio Carlos Samaia da Silva Coelho¹¹, Anatoliy V Bervitskiy¹², Egor D Anisimov¹², Jamil A Rzaev¹², Harald Krenzlin¹³, Naureen Keric¹³, Florian Ringel¹³, Dougho Park¹⁴, Mun-Chul Kim¹⁴, Eleonora Marcati¹⁵, Marco Cenzato¹⁵, Linda Krause¹⁶, Manfred Westphal¹, Lasse Dührsen¹, Thomas Sauvigny¹

Affiliations

¹ Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
³ Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁴ Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
⁵ Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
⁶ Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
⁷ Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany.
⁸ Department of Neurosurgery, University of Texas Health and Science Center at San Antonio, San Antonio, Texas, USA.
⁹ Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
¹⁰ Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
¹¹ Division of Neurological Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
¹² Federal Center of Neurosurgery, Novosibirsk, Russia.
¹³ Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany.
¹⁴ Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Korea.
¹⁵ Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹⁶ Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

PMID: 38240568
PMCID: PMC11073773 (available on 2025-01-19)
DOI: 10.1227/neu.0000000000002829

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.