Abstract
Background
The treatment of ruptured posterior circulation aneurysms remains challenging despite progresses in the endovascular and neurosurgical techniques.
Objective
To provide epidemiological characterization of subjects presenting with ruptured posterior circulation aneurysms in Switzerland and thereby assessing the treatment patterns and neurological outcomes.
Methods
This is a retrospective analysis of the Swiss SOS registry for patients with aneurysmal subarachnoid hemorrhage. Patients were divided in 3 groups (upper, lower, and middle third) according to aneurysm location. Clinical, radiological, and treatment-related variables were identified and their impact on the neurological outcome was determined.
Results
From 2009 to 2014, we included 264 patients with ruptured posterior circulation aneurysms. Endovascular occlusion was the most common treatment in all 3 groups (72% in the upper third, 68% in the middle third, and 58.8% in the lower third). Surgical treatment was performed in 11.3%. Favorable outcome (mRS ≤ 3) was found in 56% at discharge and 65.7% at 1 year. No significant difference in the neurological outcome were found among the three groups, in terms of mRS at discharge (p = 0.20) and at 1 year (p = 0.18). High WFNS grade, high Fisher grade at presentation, and rebleeding before aneurysm occlusion (p = 0.001) were all correlated with the risk of unfavorable neurological outcome (or death) at discharge and at 1 year.
Conclusions
In this study, endovascular occlusion was the principal treatment, with a favorable outcome for two-thirds of patients at discharge and at long term. These results are similar to high volume neurovascular centers worldwide, reflecting the importance of centralized care at specialized neurovascular centers.
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Change history
23 February 2019
The name of Roy Thomas Daniel was incorrectly captured in the original manuscript.
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Acknowledgements
The authors thank all past and present collaborators of the Swiss SOS study group for their support. We also than Madame Marion Brun, Department of Otorhinoloaryngology and Head and Neck Surgery, University Hospital of Lausanne (CHUV), for the artist drawing (Fig. 1).
Funding
The Department of Clinical Neurosurgery of the Lausanne University Hospital provided financial support in the form of funding for the statistical analysis. The sponsor had no role in the design or conduct of this research.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the local Ethical Committee (Geneva Ethics Committee Board no. 11-233R, NAC 11-085R) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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The results of this study were presented in part at the European Association of Neurosurgical Societis (EANS) in Athens on September 4, 2016.
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The original version of this article was revised. The name of Roy Thomas Daniel was interchanged and is now corrected.
This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm
Appendix. List of contributors to the Swiss SOS study group
Appendix. List of contributors to the Swiss SOS study group
• Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
○ Kulcsàr Zsolt, MD
• Department of Neurosurgery, University Hospital of Zurich & Clinical Neurosciences Center, University of Zurich, Switzerland
○ Emanuela Keller, MD
○ Luca Regli, MD
○ Oliver Bozinov, MD
○ Sina Finkenstädt, MD
• Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
○ Daniel Schöni, MD
○ Andreas Raabe, MD
○ Jürgen Beck, MD
○ Johannes Goldberg, MD
• Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
○ Luigi Mariani, MD
○ Raphael Guzman, MD
• Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
○ Javier Fandino, MD
○ Daniel Coluccia, MD
• Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Ospedale Civico di Lugano, Lugano, Switzerland
○ Cianfoni Alessandro, MD
• Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
○ Daniele Valsecchi, MD
○ Alessio Chiappini, MD
○ Alice Venier, MD
○ Michael Reinert, MD
• Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
○ Johannes Weber, MD
• Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
○ Andrea Ferrari, MD
○ Astrid Weyerbrock, MD
○ Gerhard Hildebrandt, MD
○ Martin Hlavica, MD
• Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Hopitaux Universitaires Genève, Geneva, Switzerland
○ Vitor Mendes Pereira, MD
• Department of Neurosurgery, Hopitaux Universitaires de Genève, Geneva, Switzerland
○ Marco Corniola, MD
○ Karl Schaller, MD
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Maduri, R., Starnoni, D., Rocca, A. et al. Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry. Acta Neurochir 161, 769–779 (2019). https://doi.org/10.1007/s00701-019-03812-9
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DOI: https://doi.org/10.1007/s00701-019-03812-9