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Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping.

Ngando HM, Maslehaty H, Schreiber L, Blaeser K, Scholz M, Petridis AK - Surg Neurol Int (2013)

Bottom Line: Postsurgically brain edema formation correlated significantly with more complex anatomical variants of the SF in patients with UIAs and in patients with Hunt and Hess 1 and 2.Ischemia rate, vasospasms, or clinical outcome was not negatively affected though.In this retrospective study, we show that the anatomical variants of the SF can be associated to postoperative complications like formation of brain edema or ischemic lesions Preoperative knowledge of the SF anatomy and possibly consecutive adapted extend of the surgical approach can decrease procedure-related morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Germany.

ABSTRACT

Background: The sylvian fissure (SF) is the anatomical pathway used in a pterional approach, which leads to most aneurysms. There are four different anatomical variants of the SF described. In the present retrospective study the four different categories of the SF were studied in order to evaluate any correlation of these variants to surgical outcome.

Methods: Patients treated for intracranial aneurysms by a pterional transsylvian approach during 2003-2012 (N = 237) were included in the study. The SF category was determined by analysis of preoperative computed tomography (CT) scanning. Patients were grouped into unruptured intracranial aneurysms (UIA) and ruptured intracranial aneurysms with subarachnoid hemorrhage (SAH) according to the Hunt and Hess grades. Brain edema, vasospasms, ischemic lesion rate, and outcome were evaluated for possible correlation with SF anatomical variants.

Results: Postsurgically brain edema formation correlated significantly with more complex anatomical variants of the SF in patients with UIAs and in patients with Hunt and Hess 1 and 2. Ischemia rate, vasospasms, or clinical outcome was not negatively affected though.

Conclusion: The classification of the SF as proposed by Yasargil is more than a pure anatomical observation. In this retrospective study, we show that the anatomical variants of the SF can be associated to postoperative complications like formation of brain edema or ischemic lesions Preoperative knowledge of the SF anatomy and possibly consecutive adapted extend of the surgical approach can decrease procedure-related morbidity.

No MeSH data available.


Related in: MedlinePlus

Severity of SAH and patient outcome. The outcome in HH 5 is significantly worse compared with all other groups of patients with SAH (**P<0.001). Numbers are given as percentage
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Figure 9: Severity of SAH and patient outcome. The outcome in HH 5 is significantly worse compared with all other groups of patients with SAH (**P<0.001). Numbers are given as percentage

Mentions: Suppl. Figure 5 illustrates the outcome of the treated patients in the different patient groups. Patients with UIAs had a very good outcome with a high number of patients in GOS 4 and 5. In HH 5 patients the mortality rate was almost 50% (27/57) and significantly higher than in any other patient groups. Even patients in HH 4 had a much lower mortality rate (2/17). In the HH4 group there were 7/17 patients with a GOS of 4 and 5, whereas in the HH5 group only 3/57 patients had a good outcome with a GOS of 4 and none had a GOS of 5.


Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping.

Ngando HM, Maslehaty H, Schreiber L, Blaeser K, Scholz M, Petridis AK - Surg Neurol Int (2013)

Severity of SAH and patient outcome. The outcome in HH 5 is significantly worse compared with all other groups of patients with SAH (**P<0.001). Numbers are given as percentage
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814910&req=5

Figure 9: Severity of SAH and patient outcome. The outcome in HH 5 is significantly worse compared with all other groups of patients with SAH (**P<0.001). Numbers are given as percentage
Mentions: Suppl. Figure 5 illustrates the outcome of the treated patients in the different patient groups. Patients with UIAs had a very good outcome with a high number of patients in GOS 4 and 5. In HH 5 patients the mortality rate was almost 50% (27/57) and significantly higher than in any other patient groups. Even patients in HH 4 had a much lower mortality rate (2/17). In the HH4 group there were 7/17 patients with a GOS of 4 and 5, whereas in the HH5 group only 3/57 patients had a good outcome with a GOS of 4 and none had a GOS of 5.

Bottom Line: Postsurgically brain edema formation correlated significantly with more complex anatomical variants of the SF in patients with UIAs and in patients with Hunt and Hess 1 and 2.Ischemia rate, vasospasms, or clinical outcome was not negatively affected though.In this retrospective study, we show that the anatomical variants of the SF can be associated to postoperative complications like formation of brain edema or ischemic lesions Preoperative knowledge of the SF anatomy and possibly consecutive adapted extend of the surgical approach can decrease procedure-related morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Germany.

ABSTRACT

Background: The sylvian fissure (SF) is the anatomical pathway used in a pterional approach, which leads to most aneurysms. There are four different anatomical variants of the SF described. In the present retrospective study the four different categories of the SF were studied in order to evaluate any correlation of these variants to surgical outcome.

Methods: Patients treated for intracranial aneurysms by a pterional transsylvian approach during 2003-2012 (N = 237) were included in the study. The SF category was determined by analysis of preoperative computed tomography (CT) scanning. Patients were grouped into unruptured intracranial aneurysms (UIA) and ruptured intracranial aneurysms with subarachnoid hemorrhage (SAH) according to the Hunt and Hess grades. Brain edema, vasospasms, ischemic lesion rate, and outcome were evaluated for possible correlation with SF anatomical variants.

Results: Postsurgically brain edema formation correlated significantly with more complex anatomical variants of the SF in patients with UIAs and in patients with Hunt and Hess 1 and 2. Ischemia rate, vasospasms, or clinical outcome was not negatively affected though.

Conclusion: The classification of the SF as proposed by Yasargil is more than a pure anatomical observation. In this retrospective study, we show that the anatomical variants of the SF can be associated to postoperative complications like formation of brain edema or ischemic lesions Preoperative knowledge of the SF anatomy and possibly consecutive adapted extend of the surgical approach can decrease procedure-related morbidity.

No MeSH data available.


Related in: MedlinePlus