The risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms: anatomical consideration and infarction territory
Purpose An anterior communicating artery is a common location for both ruptured and unruptured intracranial aneurysms, and microsurgery is sometimes necessary for their successful treatment. However, postoperative infarction should be considered during clipping due to the complex surrounding struc...
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| Veröffentlicht in: | Acta neurochirurgica 2023-02, Vol.165 (2), p.501-515 |
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Purpose
An anterior communicating artery is a common location for both ruptured and unruptured intracranial aneurysms, and microsurgery is sometimes necessary for their successful treatment. However, postoperative infarction should be considered during clipping due to the complex surrounding structures of anterior communicating artery aneurysms. This study aimed to evaluate the risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms and its clinical outcomes.
Methods
The data of patients who underwent microsurgical clipping of an unruptured anterior communicating artery aneurysm in our hospital between January 2008 and December 2020 were retrospectively analyzed. The patients’ demographic data, anatomical features of the anterior communicating artery complex and aneurysm, surgical technique, characteristics of postoperative infarction, and its clinical course were evaluated.
Results
Notably, among 848 patients, 66 (7.8%) and 34 (4%) patients had radiologic and symptomatic infarctions, respectively. Univariate and multivariate logistic regression analyses showed that hypertension (odds ratio (OR), 1.99;
p
=
0.022
), previous stroke (OR, 3.89;
p
=
0.009
), posterior projection (OR, 5.58;
p
<
0.001
), aneurysm size (OR, 1.17; optimal cut-off value, 6.14 mm;
p
=
0.002
), and skull base-to-aneurysm distance (OR, 1.15; optimal cut-off value, 11.09 mm;
p
<
0.001
) were associated with postoperative infarction. In the pterional approach, a closed A2 plane was an additional risk factor (OR, 1.88;
p
=
0.041
). Infarction of the subcallosal and hypothalamic branches was significantly associated with symptomatic infarction (
p
=
0.001
).
Conclusion
Hypertension, previous stroke, posteriorly projecting aneurysms, aneurysm size, and highly positioned aneurysms are independent risk factors for postoperative infarction during surgical clipping of an unruptured anterior communicating artery aneurysm. Additionally, a closed A2 plane is an additional risk factor of postoperative infarction in patients undergoing clipping via the pterional approach. |
| doi_str_mv | 10.1007/s00701-023-05487-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2766720851</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2775333460</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-d44aa8584aa4f6da93092f22b1d799afad8e4648e7b4eb39459948456650dcd93</originalsourceid><addsrcrecordid>eNp9kc1u1TAQhSMEoj_wAiyQJTZsQh3biWN2qKItUqVuyjryje2LS2KHsV3pPhTvyKQpULFgMx57vpkz8qmqNw390FAqzxIG2tSU8Zq2ope1elYdUyVYjYE-f5IfVScp3VHaMCn4y-qId13L8HZc_bz9Zgn49J04PeYIiURHlphyXCzo7O8t8cFpGLOPgWiXLZBUYO9HPZFx8sviw37tKQHKkgtYQ3RAykcgY5znEhDNK6QBnw9YtQUOaU4fMdU5ztuoGJI3D5KrTjBPZbEPPC53eFW9cHpK9vXjeVp9vfh8e35VX99cfjn_dF2PXLa5NkJo3bc9RuE6oxWnijnGdo2RSmmnTW9FJ3ord8LuuBKtUqIXLf4KNaNR_LR6v81dIP4oNuVh9mm004TLx5IGJrtOMtq3DaLv_kHvYoGA2yElW8656ChSbKNGiCmBdcMCftZwGBo6rGYOm5kDmjk8mDmsW7x9HF12szV_Wn67hwDfgISlsLfwV_s_Y38Br-6viw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2775333460</pqid></control><display><type>article</type><title>The risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms: anatomical consideration and infarction territory</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Rim, Hyun Taek ; Ahn, Jae Sung ; Park, Jung Cheol ; Byun, Joonho ; Lee, Seungjoo ; Park, Wonhyoung</creator><creatorcontrib>Rim, Hyun Taek ; Ahn, Jae Sung ; Park, Jung Cheol ; Byun, Joonho ; Lee, Seungjoo ; Park, Wonhyoung</creatorcontrib><description>
Purpose
An anterior communicating artery is a common location for both ruptured and unruptured intracranial aneurysms, and microsurgery is sometimes necessary for their successful treatment. However, postoperative infarction should be considered during clipping due to the complex surrounding structures of anterior communicating artery aneurysms. This study aimed to evaluate the risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms and its clinical outcomes.
Methods
The data of patients who underwent microsurgical clipping of an unruptured anterior communicating artery aneurysm in our hospital between January 2008 and December 2020 were retrospectively analyzed. The patients’ demographic data, anatomical features of the anterior communicating artery complex and aneurysm, surgical technique, characteristics of postoperative infarction, and its clinical course were evaluated.
Results
Notably, among 848 patients, 66 (7.8%) and 34 (4%) patients had radiologic and symptomatic infarctions, respectively. Univariate and multivariate logistic regression analyses showed that hypertension (odds ratio (OR), 1.99;
p
=
0.022
), previous stroke (OR, 3.89;
p
=
0.009
), posterior projection (OR, 5.58;
p
<
0.001
), aneurysm size (OR, 1.17; optimal cut-off value, 6.14 mm;
p
=
0.002
), and skull base-to-aneurysm distance (OR, 1.15; optimal cut-off value, 11.09 mm;
p
<
0.001
) were associated with postoperative infarction. In the pterional approach, a closed A2 plane was an additional risk factor (OR, 1.88;
p
=
0.041
). Infarction of the subcallosal and hypothalamic branches was significantly associated with symptomatic infarction (
p
=
0.001
).
Conclusion
Hypertension, previous stroke, posteriorly projecting aneurysms, aneurysm size, and highly positioned aneurysms are independent risk factors for postoperative infarction during surgical clipping of an unruptured anterior communicating artery aneurysm. Additionally, a closed A2 plane is an additional risk factor of postoperative infarction in patients undergoing clipping via the pterional approach.</description><identifier>ISSN: 0942-0940</identifier><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-023-05487-9</identifier><identifier>PMID: 36652012</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Aneurysm ; Aneurysm, Ruptured - complications ; Aneurysm, Ruptured - diagnostic imaging ; Aneurysm, Ruptured - surgery ; Aneurysms ; Cerebral infarction ; Humans ; Hypertension ; Hypothalamus ; Infarction - complications ; Interventional Radiology ; Intracranial Aneurysm - complications ; Intracranial Aneurysm - diagnostic imaging ; Intracranial Aneurysm - surgery ; Medicine ; Medicine & Public Health ; Microsurgery ; Minimally Invasive Surgery ; Neurology ; Neuroradiology ; Neurosurgery ; Original Article - Vascular Neurosurgery - Aneurysm ; Patients ; Retrospective Studies ; Risk Factors ; Stroke - complications ; Surgical Orthopedics ; Treatment Outcome ; Vascular Neurosurgery – Aneurysm</subject><ispartof>Acta neurochirurgica, 2023-02, Vol.165 (2), p.501-515</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-d44aa8584aa4f6da93092f22b1d799afad8e4648e7b4eb39459948456650dcd93</citedby><cites>FETCH-LOGICAL-c375t-d44aa8584aa4f6da93092f22b1d799afad8e4648e7b4eb39459948456650dcd93</cites><orcidid>0000-0002-9977-0595</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00701-023-05487-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00701-023-05487-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36652012$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rim, Hyun Taek</creatorcontrib><creatorcontrib>Ahn, Jae Sung</creatorcontrib><creatorcontrib>Park, Jung Cheol</creatorcontrib><creatorcontrib>Byun, Joonho</creatorcontrib><creatorcontrib>Lee, Seungjoo</creatorcontrib><creatorcontrib>Park, Wonhyoung</creatorcontrib><title>The risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms: anatomical consideration and infarction territory</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir</addtitle><addtitle>Acta Neurochir (Wien)</addtitle><description>
Purpose
An anterior communicating artery is a common location for both ruptured and unruptured intracranial aneurysms, and microsurgery is sometimes necessary for their successful treatment. However, postoperative infarction should be considered during clipping due to the complex surrounding structures of anterior communicating artery aneurysms. This study aimed to evaluate the risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms and its clinical outcomes.
Methods
The data of patients who underwent microsurgical clipping of an unruptured anterior communicating artery aneurysm in our hospital between January 2008 and December 2020 were retrospectively analyzed. The patients’ demographic data, anatomical features of the anterior communicating artery complex and aneurysm, surgical technique, characteristics of postoperative infarction, and its clinical course were evaluated.
Results
Notably, among 848 patients, 66 (7.8%) and 34 (4%) patients had radiologic and symptomatic infarctions, respectively. Univariate and multivariate logistic regression analyses showed that hypertension (odds ratio (OR), 1.99;
p
=
0.022
), previous stroke (OR, 3.89;
p
=
0.009
), posterior projection (OR, 5.58;
p
<
0.001
), aneurysm size (OR, 1.17; optimal cut-off value, 6.14 mm;
p
=
0.002
), and skull base-to-aneurysm distance (OR, 1.15; optimal cut-off value, 11.09 mm;
p
<
0.001
) were associated with postoperative infarction. In the pterional approach, a closed A2 plane was an additional risk factor (OR, 1.88;
p
=
0.041
). Infarction of the subcallosal and hypothalamic branches was significantly associated with symptomatic infarction (
p
=
0.001
).
Conclusion
Hypertension, previous stroke, posteriorly projecting aneurysms, aneurysm size, and highly positioned aneurysms are independent risk factors for postoperative infarction during surgical clipping of an unruptured anterior communicating artery aneurysm. Additionally, a closed A2 plane is an additional risk factor of postoperative infarction in patients undergoing clipping via the pterional approach.</description><subject>Aneurysm</subject><subject>Aneurysm, Ruptured - complications</subject><subject>Aneurysm, Ruptured - diagnostic imaging</subject><subject>Aneurysm, Ruptured - surgery</subject><subject>Aneurysms</subject><subject>Cerebral infarction</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypothalamus</subject><subject>Infarction - complications</subject><subject>Interventional Radiology</subject><subject>Intracranial Aneurysm - complications</subject><subject>Intracranial Aneurysm - diagnostic imaging</subject><subject>Intracranial Aneurysm - surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Microsurgery</subject><subject>Minimally Invasive Surgery</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Original Article - Vascular Neurosurgery - Aneurysm</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stroke - complications</subject><subject>Surgical Orthopedics</subject><subject>Treatment Outcome</subject><subject>Vascular Neurosurgery – Aneurysm</subject><issn>0942-0940</issn><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc1u1TAQhSMEoj_wAiyQJTZsQh3biWN2qKItUqVuyjryje2LS2KHsV3pPhTvyKQpULFgMx57vpkz8qmqNw390FAqzxIG2tSU8Zq2ope1elYdUyVYjYE-f5IfVScp3VHaMCn4y-qId13L8HZc_bz9Zgn49J04PeYIiURHlphyXCzo7O8t8cFpGLOPgWiXLZBUYO9HPZFx8sviw37tKQHKkgtYQ3RAykcgY5znEhDNK6QBnw9YtQUOaU4fMdU5ztuoGJI3D5KrTjBPZbEPPC53eFW9cHpK9vXjeVp9vfh8e35VX99cfjn_dF2PXLa5NkJo3bc9RuE6oxWnijnGdo2RSmmnTW9FJ3ord8LuuBKtUqIXLf4KNaNR_LR6v81dIP4oNuVh9mm004TLx5IGJrtOMtq3DaLv_kHvYoGA2yElW8656ChSbKNGiCmBdcMCftZwGBo6rGYOm5kDmjk8mDmsW7x9HF12szV_Wn67hwDfgISlsLfwV_s_Y38Br-6viw</recordid><startdate>20230201</startdate><enddate>20230201</enddate><creator>Rim, Hyun Taek</creator><creator>Ahn, Jae Sung</creator><creator>Park, Jung Cheol</creator><creator>Byun, Joonho</creator><creator>Lee, Seungjoo</creator><creator>Park, Wonhyoung</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9977-0595</orcidid></search><sort><creationdate>20230201</creationdate><title>The risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms: anatomical consideration and infarction territory</title><author>Rim, Hyun Taek ; Ahn, Jae Sung ; Park, Jung Cheol ; Byun, Joonho ; Lee, Seungjoo ; Park, Wonhyoung</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-d44aa8584aa4f6da93092f22b1d799afad8e4648e7b4eb39459948456650dcd93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aneurysm</topic><topic>Aneurysm, Ruptured - complications</topic><topic>Aneurysm, Ruptured - diagnostic imaging</topic><topic>Aneurysm, Ruptured - surgery</topic><topic>Aneurysms</topic><topic>Cerebral infarction</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypothalamus</topic><topic>Infarction - complications</topic><topic>Interventional Radiology</topic><topic>Intracranial Aneurysm - complications</topic><topic>Intracranial Aneurysm - diagnostic imaging</topic><topic>Intracranial Aneurysm - surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Microsurgery</topic><topic>Minimally Invasive Surgery</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Original Article - Vascular Neurosurgery - Aneurysm</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stroke - complications</topic><topic>Surgical Orthopedics</topic><topic>Treatment Outcome</topic><topic>Vascular Neurosurgery – Aneurysm</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rim, Hyun Taek</creatorcontrib><creatorcontrib>Ahn, Jae Sung</creatorcontrib><creatorcontrib>Park, Jung Cheol</creatorcontrib><creatorcontrib>Byun, Joonho</creatorcontrib><creatorcontrib>Lee, Seungjoo</creatorcontrib><creatorcontrib>Park, Wonhyoung</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rim, Hyun Taek</au><au>Ahn, Jae Sung</au><au>Park, Jung Cheol</au><au>Byun, Joonho</au><au>Lee, Seungjoo</au><au>Park, Wonhyoung</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms: anatomical consideration and infarction territory</atitle><jtitle>Acta neurochirurgica</jtitle><stitle>Acta Neurochir</stitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2023-02-01</date><risdate>2023</risdate><volume>165</volume><issue>2</issue><spage>501</spage><epage>515</epage><pages>501-515</pages><issn>0942-0940</issn><issn>0001-6268</issn><eissn>0942-0940</eissn><abstract>
Purpose
An anterior communicating artery is a common location for both ruptured and unruptured intracranial aneurysms, and microsurgery is sometimes necessary for their successful treatment. However, postoperative infarction should be considered during clipping due to the complex surrounding structures of anterior communicating artery aneurysms. This study aimed to evaluate the risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms and its clinical outcomes.
Methods
The data of patients who underwent microsurgical clipping of an unruptured anterior communicating artery aneurysm in our hospital between January 2008 and December 2020 were retrospectively analyzed. The patients’ demographic data, anatomical features of the anterior communicating artery complex and aneurysm, surgical technique, characteristics of postoperative infarction, and its clinical course were evaluated.
Results
Notably, among 848 patients, 66 (7.8%) and 34 (4%) patients had radiologic and symptomatic infarctions, respectively. Univariate and multivariate logistic regression analyses showed that hypertension (odds ratio (OR), 1.99;
p
=
0.022
), previous stroke (OR, 3.89;
p
=
0.009
), posterior projection (OR, 5.58;
p
<
0.001
), aneurysm size (OR, 1.17; optimal cut-off value, 6.14 mm;
p
=
0.002
), and skull base-to-aneurysm distance (OR, 1.15; optimal cut-off value, 11.09 mm;
p
<
0.001
) were associated with postoperative infarction. In the pterional approach, a closed A2 plane was an additional risk factor (OR, 1.88;
p
=
0.041
). Infarction of the subcallosal and hypothalamic branches was significantly associated with symptomatic infarction (
p
=
0.001
).
Conclusion
Hypertension, previous stroke, posteriorly projecting aneurysms, aneurysm size, and highly positioned aneurysms are independent risk factors for postoperative infarction during surgical clipping of an unruptured anterior communicating artery aneurysm. Additionally, a closed A2 plane is an additional risk factor of postoperative infarction in patients undergoing clipping via the pterional approach.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>36652012</pmid><doi>10.1007/s00701-023-05487-9</doi><tpages>15</tpages><orcidid>https://orcid.org/0000-0002-9977-0595</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0942-0940 |
| ispartof | Acta neurochirurgica, 2023-02, Vol.165 (2), p.501-515 |
| issn | 0942-0940 0001-6268 0942-0940 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Aneurysm Aneurysm, Ruptured - complications Aneurysm, Ruptured - diagnostic imaging Aneurysm, Ruptured - surgery Aneurysms Cerebral infarction Humans Hypertension Hypothalamus Infarction - complications Interventional Radiology Intracranial Aneurysm - complications Intracranial Aneurysm - diagnostic imaging Intracranial Aneurysm - surgery Medicine Medicine & Public Health Microsurgery Minimally Invasive Surgery Neurology Neuroradiology Neurosurgery Original Article - Vascular Neurosurgery - Aneurysm Patients Retrospective Studies Risk Factors Stroke - complications Surgical Orthopedics Treatment Outcome Vascular Neurosurgery – Aneurysm |
| title | The risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms: anatomical consideration and infarction territory |
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