Older Age and Single-Stage Clipping of Multiple Intracranial Unruptured Aneurysm Predict Worse One-Year Clinical Outcome

Introdução: O aneurisma intracraniano não roto (AIU) é uma doença neurovascular comum com prevalência crescente na população idosa. Objetivo: O objetivo do presente estudo é investigar o papel da idade e da abordagem neurocirúrgica em estágio único de múltiplos AIU na evolução clínica. Métodos: A presente investigação foi realizada como um estudo observacional retrospectivo não randomizado, composto por prontuários de pacientes internados no Serviço de Neurocirurgia de um centro público terciário com aneurisma intracraniano não roto, entre outubro de 2015 e junho de 2020. Aos 12 meses após a intervenção cirúrgica, todos os pacientes foram submetidos a exame neurológico para avaliar performance status e déficits neurológicos. Resultados: Um total de 227 pacientes foi incluído na presente investigação, revelando 301 aneurismas intracranianos não rotos (taxa de aneurisma por paciente de 1,3). Cento e setenta e dois (75,77%) pacientes eram do sexo feminino, com 224 (74,42%) aneurismas tratados (taxa de aneurisma: 1,3); e 55 (24,23%) eram do sexo masculino com 77 (25,58%) aneurismas operados (taxa de aneurisma: 1,4). Duzentos e doze (93,39%) pacientes apresentavam mRS ≤ 3 no sexto mês de acompanhamento, dez (4,41%) com mRS 4-5 e 5 (2,20%) morreram (mRS 6). Ao dividirmos os pacientes em dois grupos, de acordo com a distribuição da idade, de todos os indivíduos com <70 anos (221 pacientes), 193 (96,02%) concluíram o acompanhamento com mRS ≤ 3, 6 (2,99%) com mRS 4 -5 e 2 (1,00%) morreram. Por outro lado, de todos os indivíduos com ≥70 anos (26 pacientes), dezenove (73,08%) concluíram o seguimento com mRS ≤ 3, 4 (15,38%) com mRS 4-5 e 3 (11,54%) morreram. Quando divididos em grupos de acordo com o número de aneurismas operados em estágio único, de todos os indivíduos com <4 formações saculares tratados durante a cirurgia (221 pacientes), duzentos e dez (95,02%) concluíram o acompanhamento com mRS ≤ 3, oito (3,62%) com mRS 4-5 e 3 (1,36%) morreram. De todos os indivíduos com ≥4 formações saculares tratados durante a cirurgia (6 pacientes), dois (33,33%) concluíram o acompanhamento com mRS ≤ 3, dois (3,33%) com mRS 4-5 e 2 (3,33%) faleceram. Conclusão: Segundo nossos achados podemos conclur que a idade avançada e clipagem em estágio único de múltiplos UIA (≥4 lesões) predizem pior resultado clínico em um ano.

Introduction: Unruptured intracranial aneurysm (UIA) is a common neurovascular disease with increasing prevalence in older population. Objective: The aim of the present study is to investigate the role of age and single-stage neurosurgical approach of multiple UIA in the clinical outcome. Methods: The present investigation was performed as a non-randomized retrospective observational study, composed of medical records of patients admitted at the Neurosurgical Department of a public tertiary center with unruptured intracranial aneurysm, between October 2015 and June 2020. At 12 months post-surgery follow-up, all patients underwent neurological examination in order to evaluate performance status and neurological deficits. Results: A total of 227 patients were included in the present investigation, revealing 301 intracranial unruptured aneurysms (aneurysm rate per patient = 1.3). One hundred seventy-two (75.77%) patients were female with 224 (74.42%) aneurysms treated (aneurysm rate = 1.3); and 55 (24.23%) were male with 77 (25.58%) aneurysms operated (aneurysm rate = 1.4). Two hundred twelve (93.39%) patients were mRS ≤ 3 in the sixth-month follow- up, ten (4.41%) were mRS 4-5 and 5 (2.20%) died (mRS 6). After divided the patients into two groups according to the age, from all individuals with <70 years-old (221 patients), one hundred ninety-three (96.02%) ended in follow-up as mRS ≤ 3, 6 (2.99%) as mRS 4-5 and 2 (1.00%) died. On the other hand, from all individuals with ≥70 years-old (26 patients), nineteen (73.08%) ended in follow-up as mRS ≤ 3, 4 (15.38%) as mRS 4-5 and 3 (11.54%) died. After grouping of patients according to the number of aneurysms operated on a single stage approach, from all individuals with <4 saccular formations treated during surgery (221 patients), two hundred ten (95.02%) ended in follow-up as mRS ≤ 3, eight (3.62%) as mRS 4-5 and 3 (1.36%) died. On the other hand, from all individuals with
≥4 saccular formations treated during surgery (6 patients), two (33.33%) ended in follow-up as mRS ≤ 3, two (3.33%) as mRS 4-5 and 2 (3.33%) died. Conclusion: According to our findings, we can conclude that older age and single-stage clipping of multiple (≥4 lesions) UIA predict worse one-year clinical outcome.

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