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Treatment of Unruptured Intracranial Aneurysms in South Korea in 2006 : A Nationwide Multicenter Survey from the Korean Society of Cerebrovascular Surgery

  • Kim, Jeong-Eun (Department of Neurosurgery, College of Medicine, Seoul National University) ;
  • Lim, Dong-Jun (Department of Neurosurgery, College of Medicine, Korea University) ;
  • Hong, Chang-Ki (Department of Neurosurgery, College of Medicine, Yonsei University) ;
  • Joo, Sung-Pil (Department of Neurosurgery, College of Medicine, Chonnam University) ;
  • Yoon, Seok-Mann (Department of Neurosurgery, College of Medicine, Soonchunhyang University) ;
  • Kim, Bum-Tae (Department of Neurosurgery, College of Medicine, Soonchunhyang University)
  • Published : 2010.02.20

Abstract

Objective : There have been no clinical studies regarding the epidemiology and treatment outcome for unruptured intracranial aneurysm (UIA) in South Korea yet. Thus, The Korean Society of Cerebrovascular Surgery (KSCVS) decided to evaluate the clinical and epidemiological characteristics, and outcome of the treatment of UIA in 2006, using the nationwide multicenter survey in South Korea. Methods : A total of 1,696 cases were enrolled retrospectively over one year at 48 hospitals. The following data were obtained from all patients : age, sex, presence of symptoms, location and size of the aneurysm, treatment modality, presence of risk factors for stroke, and the postoperative 3D-day morbidity and mortality. Results : The demographic data showed female predominance and peak age of seventh and sixth decades. Supraclinoid internal carotid artery was the most common site of aneurysms with a mean size of 5.6 mm. Eight-hundred-forty-six patients (49.9%) were treated with clipping, 824 (48.6%) with coiling, and 26 with combined method. The choice of the treatment modalities was related to hospital (p=0.000), age (p=0.000), presence of symptom (p=0.003), and location of aneurysm (p=0.000). The overall 30-day morbidity and mortality were 7.4% and 0.3%, respectively. The 30-day mortality was 0.4% for clipping and 0.2% for coiling, and morbidity was 8.4% for clipping and 6.3% for coiling. Age (p=0.010), presence of symptoms (p=0.034), size (p=0.000) of aneurysm, and diabetes mellitus (p=0.000) were significant prognostic factors, while treatment modality was not. Conclusion : This first nation-wide multicenter survey on UIAs demonstrates the epidemiological and clinical characteristics, outcome and the prognostic factors of the treatment of UIAs in South Korea. The 30-day postoperative outcome for UIAs seems to be reasonable morbidity and mortality in South Korea.

Keywords

References

  1. Barker FG 2nd, Amin-Hanjani S, Butler WE, Hoh BL, Rabinov JD, Pryor JC, et al. : Age-dependent differences in short-term outcome after surgical or endovascular treatment of unruptured intracranial aneurysms in the United States, 1996-2000. Neurosurgery 54 : 18-28; discussion 28-30, 2004 https://doi.org/10.1227/01.NEU.0000097195.48840.C4
  2. da Costa LB, Gunnarsson T, Wallace MC : Unruptured intracranial aneurysms : Natural history and management decisions. Neurosurg Focus 17 : E6, 2004 https://doi.org/10.3171/foc.2004.17.2.2
  3. de la Monte SM, Moore GW, Monk MA, Hutchins GM : Risk factors for the development and rupture of intracranial berry aneurysms. Am J Med 78 : 957-964, 1985 https://doi.org/10.1016/0002-9343(85)90218-9
  4. de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ : Incidence of subarachnoid haemorrhage : a systematic review with empha-sis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 78 : 1365-1372, 2007 https://doi.org/10.1136/jnnp.2007.117655
  5. Feigin VL, Rinkel GJ, Lawes CM, Algra A, Bennett DA, van Gijn J, et al. : Risk factors for subarachnoid hemorrhage : an updated systematic review of epidemiological studies. Stroke 36 : 2773-2780, 2005 https://doi.org/10.1161/01.STR.0000190838.02954.e8
  6. Higashida RT, Lahue BJ, Torbey MT, Hopkins LN, Leip E, Hanley DF : Treatment of unruptured intracranial aneurysms : a nationwide assessment of effectiveness. AJNR Am J Neuroradiol 28 : 146-151, 2007
  7. Inagawa T, Takahashi M, Aoki H, Ishikawa S, Yoshimoto H : Aneurysmal subarachnoid hemorrhage in izumo City and Shimane Prefecture of Japan. Outcome. Stroke 19 : 176-180, 1988 https://doi.org/10.1161/01.STR.19.2.176
  8. Linn FH, Rinkel GJ, Algra A, van Gijn J : Incidence of subarachnoid hemorrhage : role of region, year, and rate of computed tomography : a meta-analysis. Stroke 27 : 625-629, 1996 https://doi.org/10.1161/01.STR.27.4.625
  9. Moroi J, Hadeishi H, Suzuki A, Yasui N : Morbidity and mortality from surgical treatment of unruptured cerebral aneurysms at Research Institute for Brain and Blood Vessels-Akita. Neurosurgery 56 : 224-231; discussion 224-231, 2005 https://doi.org/10.1227/01.NEU.0000148897.28828.85
  10. Ogilvy CS, Carter BS : Stratification of outcome for surgically treated unruptured intracranial aneurysms. Neurosurgery 52 : 82-87; discussion 87-88, 2003
  11. Raaymakers TW, Rinkel GJ, Limburg M, Algra A : Mortality and morbidity of surgery for unruptured intracranial aneurysms : a metaanalysis. Stroke 29 : 1531-1538, 1998 https://doi.org/10.1161/01.STR.29.8.1531
  12. Rinkel GJ, Djibuti M, Algra A, van Gijn J : Prevalence and risk of rupture of intracranial aneurysms : a systematic review. Stroke 29 : 251-256, 1998 https://doi.org/10.1161/01.STR.29.1.251
  13. Stehbens WE : Aneurysms and anatomical variation of cerebral arteries. Arch Pathol 75 : 45-64, 1963
  14. Wardlaw JM, White PM: The detection and management of unruptured intracranial aneurysms. Brain 123 : 205-221, 2000 https://doi.org/10.1093/brain/123.2.205
  15. Wiebers DO : Unruptured intracranial aneurysms : natural history and clinical management. Update on the international study of unruptured intracranial aneurysms. Neuroimaging Clin N Am 16 : 383-390, 2006 https://doi.org/10.1016/j.nic.2006.04.005
  16. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, et al. : Unruptured intracranial aneurysms : natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362 : 103-110, 2003 https://doi.org/10.1016/S0140-6736(03)13860-3

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