Rahmanian Abdolkarim, Ghaffarpasand Fariborz, Alibai Ehsanali, Choque-Velasquez Joham, Jahromi Behnam Rezai, Hernesniemi Juha
Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
World Neurosurg. 2018 Feb;110:e605-e611. doi: 10.1016/j.wneu.2017.11.060. Epub 2017 Nov 21.
To report the outcome of patients with very small intracranial aneurysm (VSIA) undergoing surgical clipping using a double-clip technique.
This cross-sectional study was conducted in Namazi Hospital, the main referral neurovascular center in Southern Iran during a 6-year period from September 2010 to March 2016. All patients with VSIAs (≤3 mm) undergoing surgery with double-clip technique were included. This technique reduces the clip slippage. The short- and long-term outcomes determined by Glasgow outcome score (GOS), modified Rankin Scale (MRS), and complications.
Operations were performed on 32 VSIAs in 26 patients with a mean ± SD age of 55.7 ± 10.1 years. Middle cerebral artery was the most common location for VSIA (50.0%). There was no neck remnant, and the complete occlusion rate was 100%. The rate of intraoperative aneurysm rupture was 30.8%, and none of the patients experienced rebleeding. The 6-month mortality rate was 0% in ruptured VSIAs and 6.25% in unruptured VSIAs. Most of the patients had favorable outcomes (88.5%), and the overall mortality rate was 11.5%. The rate of permanent neurologic deficit was 10.0% in ruptured and 12.5% in unruptured VSIAs. Multivariate logistic regression analysis revealed no association between baseline and clinical characteristics and outcome in this series.
VSIAs are difficult to treat because of their small sizes; therefore, with a double-clip technique, one can reduce complications related to the treatment of small aneurysms.
报告采用双夹技术对颅内微小动脉瘤（VSIA）患者进行手术夹闭的结果。
本横断面研究于2010年9月至2016年3月的6年期间，在伊朗南部主要的神经血管转诊中心纳马齐医院进行。纳入所有采用双夹技术进行手术的VSIA（≤3mm）患者。该技术可减少夹子滑脱。通过格拉斯哥预后评分（GOS）、改良Rankin量表（MRS）和并发症来确定短期和长期结果。
对26例患者的32个VSIA进行了手术，患者平均年龄±标准差为55.7±10.1岁。大脑中动脉是VSIA最常见的位置（50.0%）。无颈部残留，完全闭塞率为100%。术中动脉瘤破裂率为30.8%，无患者发生再出血。破裂VSIA的6个月死亡率为0%，未破裂VSIA的为6.25%。大多数患者预后良好（88.5%），总死亡率为11.5%。破裂VSIA的永久性神经功能缺损率为10.0%，未破裂VSIA的为12.5%。多因素逻辑回归分析显示，本系列中基线和临床特征与结果之间无关联。
VSIA因其尺寸小而难以治疗；因此，采用双夹技术可减少与小动脉瘤治疗相关的并发症。
