Patra Devi Prasad, Bir Shyamal C, Maiti Tanmoy K, Kalakoti Piyush, Cuellar-Saenz Hugo H, Guthikonda Bharat, Sun Hai, Nanda Anil
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
World Neurosurg. 2016 Oct;94:229-238. doi: 10.1016/j.wneu.2016.07.007. Epub 2016 Jul 14.
Endovascular treatment in the present form has almost taken over the management of posterior circulation aneurysms. However, superior cerebellar artery (SCA) aneurysms are among the few that are said to be surgeon friendly with comparable outcome with microsurgery. This study includes a comparative analysis of the SCA aneurysms treated with microsurgery and endovascular techniques at our institute along with a pooled analysis of available literature on overall outcomes in these 2 forms of treatment.
This retrospective study included our patients with SCA aneurysms from 2000 to 2015. Clinical outcomes were assessed by the Glasgow Outcome Scale (GOS) at discharge and modified Rankin Scale (mRS) at follow-up. A literature review was performed for clinical series on SCA aneurysms from 1991 to 2015 describing more than 10 patients for pooled analysis.
Among the 20 patients (microsurgery, 12; endovascular, 8), 66% from microsurgery and 75% from the endovascular arm had good outcomes (GOS score >3 and mRS score <3) (P = 0.54). Microsurgery had an 88.8% complete occlusion rate compared with 75% in endovascular treatment (P = 0.45). Pooled analysis of 12 studies showed that endovascular coiling is significantly associated with good clinical outcome (88.1% vs. 76.9%; P = 0.003). Microsurgery provides better radiologic outcome in terms of complete occlusion rate (90.1% vs. 67.4%; P = 0.0001) and lower recurrence rate (0% vs. 11.8%; P = 0.005).
Individual series on SCA aneurysms have not proved any outcome benefit of either treatment modality over the other. However, pooled analysis suggests that microsurgery provides complete and sustainable aneurysm occlusion, although with an inferior clinical outcome.
目前形式的血管内治疗几乎已取代后循环动脉瘤的管理。然而，小脑上动脉（SCA）动脉瘤是少数被认为对手术医生友好且与显微手术疗效相当的动脉瘤之一。本研究包括对我院采用显微手术和血管内技术治疗的SCA动脉瘤进行对比分析，并对这两种治疗方式总体疗效的现有文献进行汇总分析。
这项回顾性研究纳入了2000年至2015年我院患有SCA动脉瘤的患者。临床疗效通过出院时的格拉斯哥预后量表（GOS）和随访时的改良Rankin量表（mRS）进行评估。对1991年至2015年描述超过10例患者的SCA动脉瘤临床系列进行文献综述以进行汇总分析。
在20例患者中（显微手术组12例；血管内治疗组8例），显微手术组66%以及血管内治疗组75%的患者获得了良好疗效（GOS评分>3且mRS评分<3）（P = 0.54）。显微手术的完全闭塞率为88.8%，而血管内治疗为75%（P = 0.45）。对12项研究的汇总分析表明，血管内栓塞与良好的临床疗效显著相关（88.1%对76.9%；P = 0.003）。就完全闭塞率（90.1%对67.4%；P = 0.0001）和较低的复发率（0%对11.8%；P = 0.005）而言，显微手术提供了更好的影像学疗效。
关于SCA动脉瘤的单个系列研究尚未证明任何一种治疗方式比另一种具有疗效优势。然而，汇总分析表明，显微手术可实现动脉瘤的完全和持久闭塞，尽管临床疗效较差。
