Outcome after treatment of cerebral aneurysms

Abstract

A cerebral aneurysm is a saccular or tubular-like deformity of the arterial vessel wall which is usually thinner. The rupture of a cerebral aneurysm is associated with a high morbidity and mortality by causing an aneurysmal subarachnoid haemorrhage (aSAH). Treatment, which can be surgical or endovascular, aims to isolate the aneurysm from the normal blood circulation to prevent rupture. The decision to treat is based on several factors, including size, location, shape of the aneurysm, patient age, potential co-morbidities, potential risks associated with aneurysm treatment. The aim of this thesis has been to report the long-term outcomes, both neurological and radiological, in patients that have been treated for an cerebral aneurysm, both ruptured and unruptured. In study I, the neurological long-term outcome in patients that have previously suffered an aSAH was good, despite this; more than 60% of the patients still reported mental fatigue of some degree. Study II assessed the neurological and radiological outcome in patients with refractory cerebral vasospasm that received intra-arterial nimodipine (IAN). We could with this study conclude that the majority still suffered an ischemic cerebral infarction and that a good clinical recovery was seen in almost half of the patients. In study III, an 18-year follow-up in patients previously treated for an intracranial aneurysm (IA) was performed where we identified 13.6% of these with a de novo aneurysm. In study IV, we performed a single centre follow-up of patients that had been treated at our institute with a flow diverter where we in the follow-up identified three-quarters of the aneurysms treated to have an aneurysm occlusion and that patients >70 years had a lower occlusion rate. Conclusion and implications: A longer neurological and radiological follow-up time is deemed necessary, especially in the younger patient population, after having been diagnosed and treated for an intracranial aneurysm. A majority of the patients receiving intra-arterial nimodipine suffered a cerebral infarction; despite this, approximately half of all patients had a good neurological outcome after 6 months. Flow diverters have an acceptable occlusion rate in patients <70 years of age, and this treatment offers a reasonably safe alternative in patients with aneurysms posing a high risk of causing potential harm to the patients. Keywords: Intracranial aneurysm, intra-arterial nimodipine, de novo aneurysm, flow diverter