Department of Neurosurgery, Johann Wolfgang Goethe-University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
Acta Neurochir (Wien). 2011 Jun;153(6):1247-52. doi: 10.1007/s00701-011-1008-3. Epub 2011 Apr 13.
The objective was to assess the surgical results in complex middle cerebral artery (MCA) aneurysms.
From 1999 to 2009 the data of 330 patients with ruptured and unruptured MCA aneurysms were included into a prospective database. Degree of aneurysm occlusion and clinical outcomes were analysed after 271 surgical and 59 endovascular treatments assigned in an interdisciplinary approach. Aneurysms of large size and/or broad base, calcifications, and incorporation of M1 or M2 segments into the aneurysm base were defined as complex.
At least one of the criteria for complexity mentioned above was met in 97.8% of the MCA aneurysms that were treated surgically and in 76.3% that were treated endovascularly. In MCA aneurysms treated surgically, complete occlusion was achieved in 264 of the 271 (97.4%) aneurysms. Aneurysms with remnants after surgical treatment were significantly larger in size (17 ± 3 mm vs 7 ± 5 mm), and exhibited significantly more often parent vessel involvement (M1: 86% vs 27%; M2: 100% vs 67%) compared with the group of aneurysms that could be treated without remnant. Compared with our institutional data (52.5% complete occlusion rate) and data of the literature (up to 46.1% complete occlusion rate), the occlusion rates of endovascularly treated MCA aneurysms were significantly lower compared with MCA aneurysms treated surgically.
Surgical treatment of ruptured and unruptured MCA aneurysms results in a significantly higher rate of complete aneurysm occlusion compared with endovascular treatment, despite a high rate of complex aneuryms in the surgically treated group.
本研究旨在评估复杂大脑中动脉（MCA）动脉瘤的手术治疗效果。
1999 年至 2009 年，我们前瞻性地收集了 330 例破裂和未破裂 MCA 动脉瘤患者的数据，并纳入到一个数据库中。通过对 271 例手术治疗和 59 例血管内治疗的分析，评估了MCA 瘤体闭塞程度和临床预后。采用多学科联合治疗策略，将瘤体大、基底宽、钙化、MCA 主干或分支动脉受累的动脉瘤定义为复杂动脉瘤。
在接受手术治疗的 MCA 动脉瘤中，有 97.8%（271 例中的 264 例）和接受血管内治疗的 MCA 动脉瘤中 76.3%（59 例中的 46 例）符合上述复杂动脉瘤的一个或多个标准。在接受手术治疗的 MCA 动脉瘤中，完全闭塞率为 97.4%（271 例中的 264 例）。与无瘤体残留的 MCA 动脉瘤相比，有瘤体残留的动脉瘤的体积更大（17 ± 3mm 比 7 ± 5mm），且更常累及载瘤动脉（M1：86%比 27%；M2：100%比 67%）。与本机构的数据（52.5%的完全闭塞率）和文献数据（最高为 46.1%的完全闭塞率）相比，血管内治疗 MCA 动脉瘤的闭塞率明显低于手术治疗。
尽管手术治疗组中复杂动脉瘤的比例较高，但与血管内治疗相比，手术治疗破裂和未破裂 MCA 动脉瘤的完全闭塞率更高。
