Hirnarterienaneurysmatherapie- endovaskuläre Therapie oder offene Operation. Behandlungsergebnisse und subjektive Patienteneinschätzung
therapy of cerebral Aneurysm- endovascular coiling versus surgical clipping. Results of treatment and subjective patient statements.
by Sebastian Voß
Date of Examination:2015-03-10
Date of issue:2015-03-04
Advisor:Prof. Dr. Michael Knauth
Referee:Prof. Dr. Michael Knauth
Referee:PD Dr. Dorothee Mielke
Referee:Prof. Dr. George Trendelenburg
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EnglishBackground: The aim of this study is to compare the longterm outcome of patients with microsurgical clipping and endovasculare coil embolization basis of objective and subjective parameters. Methods: Data from 161 patients of University of Göttingen between November 2003 and November 2011 were retrospectively reviewed. Analysis compared outcomes in patients treated with surgical clipping versus endovascular coiling. Subgroups were build in patients with innocent aneurysm and patients with aneurysmal subarachnoidal hemorrhage (aSAH). In addition to objective parameters, including the assessment of the neurological state of the patient and the process of history, a subjective survey of the patient based on a questionnaire was carried out. 82 of the 161 patients with cerebral aneurysm between the age of 21 and 84 years evaluated the questionnaire. The questionnaire includes, among others, five dimensions of quality of life and allows recording of the HRQL (ROSE 2003 et al) Results: The mean age at the time of treatment was 54,29 years ± 13,82 (range 21-84 years). Patients being clipped were almost four years older than patients being coiled (Clip:Coil= 56,22 years ± 13,83: 52,56 years ± 13,67). The mean maximal aneurysm diameter was 9,26 ± 5,29 (range 2,5-25mm). The 161 patients consisted of 104 women and 57 men. A total of 112 aneruysm were ruptured (Clip:Coi=42%:58%), 49 were non-ruptured/innocent (Clip:Coil= 40,8%:59,2%; p=0,0440). Oft he 161 patients, 82 (51%) patients could be won fort he interview. Patients with innocentem aneurysm showed no differences mainly. Only rehabilitive measures was required more frequently after clipping than after coil embolization (clip: 57,9%, n=11; coil: 16,7% n=2; p=0,0113). In case of aSAH, mostly better results are observed on the part of the endovasculare procedure, in which the level of significance was’ nt reached frequently: patients getting clipped showed a more bad non signifikantly neurological status than patients getting coiled (mRS, p=0,0506). The quality of life showed no significant differents in three of five dimensions (physical function, physical role function, physical pain). Clear differences were seen in the kognitive dimension (p=0,0069) and generally perception of own healthy (p=0,0543), with a better result under the endovascular treated. With a positive correlation (τ=0,1757) between length of hospital-stay (in days) and the degree of neurological impairment (mRS) both methods showed relatively balanced legth of tay (Clip:Coil=25,68 days ± 17,77: 22,82 days ± 16,55; p=0.6418). Conclusion: The outcome is not significantly different between neurosurgical and endovascular treated patients with innocent, non-ruptured aneurysm. Patients with aSAH showed in most parameters a better, non-significant outcome after beeing coiled. Especially endovascular treatment may cause less limitation in kognitve function and generally perception of own healthy.
Keywords: Clipping; aneurysm; saH; Coiling; innocent
Schlagwörter: Aneurysmatherapie; Clipping; SAB; Coiling; Aneurysma; Lebensqualität