Park Wonhyoung, Chung Jaewoo, Ahn Jae Sung, Park Jung Cheol, Kwun Byung Duk
Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
World Neurosurg. 2017 Jun;102:301-312. doi: 10.1016/j.wneu.2017.03.028. Epub 2017 Mar 16.
This study aimed to assess the clinical and radiologic outcomes after neurosurgical treatment of large and giant aneurysms of the middle cerebral artery (MCA). In addition, we aimed to identify risk factors for unfavorable outcomes.
This retrospective study included 105 patients with 106 large or giant MCA aneurysms treated with neurosurgical methods, including microsurgery and endovascular treatment, over a 15-year period.
The mean aneurysm size was 15.3 ± 7.1 mm. Ten (9.4%) were giant aneurysms. The MCA bifurcation was the most common aneurysm site, followed by the MCA trunk and distal MCA. Aneurysm clipping was the most common treatment method, followed by clipping or trapping with bypass surgery and endovascular treatment. However, acute cerebral infarction was the most common complication (16.0%), poor outcomes (modified Rankin Scale score, 3-6) developed in 12.3% of aneurysms after treatment, and 6.6% of treated aneurysms needed retreatment. Multivariate analysis showed that independent risk factors for acute cerebral infarction after treatment were aneurysms located on the MCA trunk and 2 or more underlying diseases. Initial presentation with subarachnoid hemorrhage and complications during treatment were independent risk factors for poor outcomes. In addition, endosaccular coiling was an independent risk factor for retreatment.
Neurosurgical management should be considered a priority for large and giant MCA aneurysms because of the high rupture rate and clinical symptoms. However, treatment outcomes remain unsatisfactory. Therefore, tailored management with consideration of risk factors for unfavorable outcomes should be implemented.
本研究旨在评估大脑中动脉（MCA）大型和巨大动脉瘤神经外科治疗后的临床和影像学结果。此外，我们旨在确定不良结果的危险因素。
这项回顾性研究纳入了105例患者，他们在15年期间接受了神经外科治疗，包括显微手术和血管内治疗，共治疗106个大型或巨大MCA动脉瘤。
动脉瘤平均大小为15.3±7.1mm。10个（9.4%）为巨大动脉瘤。MCA分叉是最常见的动脉瘤部位，其次是MCA主干和MCA远端。动脉瘤夹闭是最常见的治疗方法，其次是夹闭或联合搭桥手术的圈套术以及血管内治疗。然而，急性脑梗死是最常见的并发症（16.0%），治疗后12.3%的动脉瘤出现不良结果（改良Rankin量表评分，3 - 6分），6.6%的治疗动脉瘤需要再次治疗。多因素分析显示，治疗后急性脑梗死的独立危险因素是位于MCA主干的动脉瘤以及2种或更多种基础疾病。蛛网膜下腔出血的初始表现和治疗期间的并发症是不良结果的独立危险因素。此外，瘤内栓塞是再次治疗的独立危险因素。
由于大型和巨大MCA动脉瘤破裂率高且有临床症状，神经外科治疗应被视为优先选择。然而，治疗结果仍不尽人意。因此，应实施考虑不良结果危险因素的个体化治疗。
