Dammann Philipp, Schoemberg Tobias, Müller Oliver, Özkan Neriman, Schlamann Marc, Wanke Isabel, Sandalcioglu I Erol, Forsting Michael, Sure Ulrich
Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany,
Neurosurg Rev. 2014 Oct;37(4):643-51. doi: 10.1007/s10143-014-0563-5. Epub 2014 Jul 9.
The rupture of an intracranial aneurysm leads to subarachnoid hemorrhage (SAH). To prevent SAH, unruptured lesions can be treated by either endovascular or microsurgical approach. Due to their complex anatomy, middle cerebral artery (MCA) aneurysms represent a unique subgroup of intracranial aneurysms. Primary objective was to determine radiological and clinical outcomes in patients with middle cerebral artery aneurysms who were interdisciplinary treated by either endovascular or microsurgical approach in a single center. Secondary objective was to determine the impact of the lesions' angiographic characteristics on treatment outcome. Clinical and radiological data of 103 patients interdisciplinary treated for unruptured MCA aneurysms over a 5-year period were analyzed in endovascular (n = 16) and microsurgical (n = 87) cohorts. Overall morbidity (Glasgow Outcome Score <5) after 12-month follow-up was 9 %. There was no significant difference between the two cohorts. Complete or "near complete" aneurysm occlusion was achieved in 97 and 75 % in the microsurgical, respective endovascular cohort. A "complex" aneurysm configuration had a significant impact on complete aneurysm occlusion in both cohorts, however, not on clinical outcome. Treatment of unruptured MCA aneurysms can be performed with a low risk of repair using both approaches. However, the risk for incomplete occlusion was higher for the endovascular approach in this series.
颅内动脉瘤破裂会导致蛛网膜下腔出血（SAH）。为预防SAH，未破裂的病变可通过血管内或显微外科方法进行治疗。由于其复杂的解剖结构，大脑中动脉（MCA）动脉瘤是颅内动脉瘤的一个独特亚组。主要目的是确定在单一中心接受血管内或显微外科跨学科治疗的大脑中动脉动脉瘤患者的影像学和临床结果。次要目的是确定病变的血管造影特征对治疗结果的影响。对103例在5年期间接受未破裂MCA动脉瘤跨学科治疗的患者的临床和影像学数据在血管内治疗组（n = 16）和显微外科治疗组（n = 87）中进行了分析。12个月随访后的总体发病率（格拉斯哥预后评分<5）为9%。两组之间无显著差异。显微外科治疗组和血管内治疗组的动脉瘤完全或“接近完全”闭塞率分别为97%和75%。“复杂”的动脉瘤形态对两组的动脉瘤完全闭塞有显著影响，但对临床结果无影响。两种方法治疗未破裂MCA动脉瘤的修复风险都较低。然而，在本系列中，血管内治疗方法不完全闭塞的风险更高。
