Cephalgia Following Flow Diversion of Unruptured Intracranial Aneurysms
Notice bibliographique
Résumé
BACKGROUND: Headaches following treatment of unruptured intracranial aneurysms with flow diverting stents is a known, however under-reported, entity. Prevalence of this phenomenon, its clinical and procedural correlates, as well as its clinical course and correlation to aneurysm location and size have not been reported in the past. This manuscript aims to quantify the prevalence of the phenomenon, describe its natural course, and identify risk factors for its emergence. METHODS: Within our prospectively collected institutional database, we identified 141 consecutive patients treated electively for unruptured intracranial aneurysms by flow diversion between 2015 and 2021 who had a minimum of 2 years of clinical follow-up. The mean patient age was 55.7 (±13) y/o and 120/141 patients (85%) were females. Based on chart review and clinical notes we evaluated the presence of postprocedural headache complaints and correlated these with anatomical and periprocedural data. Additionally we have assessed charts of 88 patient who underwent aneurysm coiling without flow diversion during the same time period. RESULTS: Twenty-four (17%) patients complained of new headaches postflow diversion which were hemicranial or holocranial (n = 17) or retro-orbital (n = 7) in nature. Headaches were most common in paraclinoid, paraophthalmic, and cavernous aneurysms, while retro-orbital pain was correlated to larger aneurysms of same locations mean dimensions and older age (Pearson's correlation, 13 mm ± 5.4, P = 0.04; 65 ± 14, P = 0.048). Two stent constructs were also correlated to retro-orbital headaches (hazard ratio [HR] 3.8, P = 0.03, confidence interval [CI] 1.0-16.4). In addition, in 15 of 24 cases (62.5%) of headache presentations, the stent construct was crossing the dura. In 6 of 7 (87.5%) of patients presenting with retro-orbital headaches the stent construct was crossing the dural ring. The clinical course of the pain syndrome was invariably benign and short-lived (<1 year long). During the same time period only 3 patients (3.4%) in the elective coiling without flow diverter group presented with various duration of holocranial eventually resolving headaches. CONCLUSIONS: In our cohort, new postprocedural headaches following flow-diversion were present in 17% of patients thus constituting a common adverse event that was exclusively related to anterior circulation aneurysms, in contrast to only 3.4% prevalence of new postprocedural headaches following elective aneurysm coiling. The phenomenon was short-lived and benign, related to larger aneurysm size, proximity to the dural ring in the treated segment, double stent construct, and older age. We hypothesize that these headaches may be related to meningeal irritation. We recommend that patients are educated during the consent process of this phenomenon and its clinical course prior to treatment.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».