Evaluation of long-term results in cerebral aneurysm treatment

Objective: To retrospectively compare surgical and endovascular treatment methods in intracranial aneurysms over an 18-year period. Material and Methods: A total of 1183 (722 females, 461 males; mean age 51.29±12.44 years) patients diagnosed with "intracranial aneurysm" in Istanbul University, Istanbul Faculty of Medicine, Department of Neurosurgery between 2001-2018 were analyzed. Results of surgical and endovascular treatment methods, epidemiological data, localization of aneurysm, World Federation of Neurosurgical Societies (WFNS) grade, symptoms on admission to hospital, neurological examination findings before and after treatment, other diseases affecting mortality and morbidity, complications, mortality, transient and permenant neurologic deficits, rest filling in control digital subtraction angiography (DSA), and Glasgow Outcome Scale (GOS) at discharge were compared. Results: When the mean GOS of surgical and endovascular treatment methods were compared with covariance analysis, no significant difference was found between the two groups (p=0.542). However, when the aneurysms were classified and evaluated according to their localization, the GOS results of the surgical group in anterior communicating artery (ACoA) aneurysms were found to be statistically significantly higher than the endovascular group (p=0.004). Especially in ICA and VBS aneurysms, due to the preference of endovascular method in recent years, the lack of aneurysms closed by surgical method is one of the limitations of this study. There was no statistically signicant difference between the two treatment methods in other localizations. When the control DSA results after the procedure were examined, rest aneurysm was observed at a rate of 11.5% in the surgical treatment group and 41.6% in the endovascular treatment group (p=0.001). Considering the mortality and morbidity rates of both methods, no significant difference was found between them. Even in localizations suitable for surgical treatment such as ACoA aneurysms, it has been observed that the rate of preference for the endovascular method has increased in recent years.