Niskanen Minna, Koivisto Timo, Rinne Jaakko, Ronkainen Antti, Pirskanen Sanna, Saari Tapani, Vanninen Ritva
Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland.
J Neurosurg Anesthesiol. 2005 Apr;17(2):100-5. doi: 10.1097/01.ana.0000163202.33236.ml.
Endovascular treatment has become a feasible alternative in the management of aneurysmal subarachnoid hemorrhage. After endovascular or surgical treatment of patients with unruptured intracranial aneurysms (UIAs), little is known about the practices of observation or need for intensive care. We analyzed retrospectively perioperative complications that were associated with the procedure and postoperative care in patients undergoing management of UIAs. A total of 53 patients underwent endovascular treatment and 105 patients surgical treatment. Location of the aneurysm was the main determinant of the modality of treatment. In the endovascular group, 34 patients were conscious during the procedure and 19 were under general anesthesia. Six patients in the endovascular and 9 in the surgical group experienced complications during the procedure. After the procedure, complications were more common in the surgical group than in the endovascular group (11 versus 0 patients, P = 0.015). Six of the postoperative complications of surgically treated patients occurred in the intensive care unit. Two patients in the endovascular group and five in the surgical group had major neurologic deficits as a consequence of complications. One surgically treated patient died. Both endovascular and surgical treatment of UIAs carry risks that may result in severe neurologic impairment. Patients should be observed with equal vigilance with either treatment option. Surgical treatment is associated with emergencies that require prompt interventions postoperatively and therefore close observation in an ICU setting may be preferable in patients who have undergone surgical treatment of UIAs. Complications after uneventful endovascular procedures seem to be rare.
血管内治疗已成为动脉瘤性蛛网膜下腔出血管理中的一种可行替代方案。在对未破裂颅内动脉瘤（UIA）患者进行血管内或手术治疗后，对于观察措施或重症监护需求的做法了解甚少。我们回顾性分析了接受UIA治疗患者的围手术期与手术及术后护理相关的并发症。共有53例患者接受了血管内治疗，105例患者接受了手术治疗。动脉瘤的位置是治疗方式的主要决定因素。在血管内治疗组中，34例患者在手术过程中清醒，19例接受全身麻醉。血管内治疗组有6例患者、手术组有9例患者在手术过程中出现并发症。手术后，手术组的并发症比血管内治疗组更常见（分别为11例和0例患者，P = 0.015）。手术治疗患者的术后并发症中有6例发生在重症监护病房。血管内治疗组有2例患者、手术组有5例患者因并发症出现严重神经功能缺损。1例接受手术治疗的患者死亡。UIA的血管内和手术治疗均有风险，可能导致严重神经功能损害。无论选择哪种治疗方案，都应同样警惕地观察患者。手术治疗会引发术后需要迅速干预的紧急情况，因此对于接受UIA手术治疗的患者，在重症监护病房密切观察可能更为可取。血管内手术过程顺利后的并发症似乎很少见。
