Steklacova Anna, Bradac Ondrej, de Lacy Patricia, Lacman Jiri, Charvat Frantisek, Benes Vladimir
Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, U Vojenske Nemocnice 1200, Praha 6, 169 02, Prague, Czech Republic.
Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK.
Neurosurg Rev. 2018 Jul;41(3):825-839. doi: 10.1007/s10143-017-0932-y. Epub 2017 Nov 28.
Endovascular techniques are still expanding in their capability by introducing novel technologies. Nevertheless, anterior communicating artery (ACoA) remains the region with high propensity for aneurysm (AN) re-growth after endovascular intervention. The purpose of this study is to highlight the ongoing importance for microsurgical treatment. The authors conducted a single-institution retrospective study of ACoA AN treatment between January 2000 and December 2016 maintaining "coil mainly" policy. The results are supplied with a systematic review of the literature. A total of n = 398 ACoA ANs were treated in n = 398 consecutive patients (207 females, 191 males). Microsurgical treatment was performed for 79 AN patients (54 ruptured, 25 unruptured), and 319 AN patients (250 ruptured, 69 unruptured) underwent coiling procedure. Treatment-related morbidity and mortality (MM) for unruptured ANs was 0% in the microsurgical and 1.5% in the endovascular group (p = 1.000). The percentage of patients with none or minor permanent deficits after subarachnoid hemorrhage was 74% in the microsurgical and 70% in the endovascular group (p = 0.693). The re-treatment rate was 3.8% in microsurgical group and 9.2% in endovascular group (p = 0.883). A literature review identified 39 studies concerning ACoA AN treatment. Clinical results of both modalities were comparable, with microsurgery being superior regarding radiological outcomes. This study demonstrates that both treatment techniques bring comparable clinical benefit to the patient. Microsurgery seemed superior regarding radiological outcomes. The decision about the treatment strategy should be made by a multi-disciplinary team consisting of specialists from both teams, bearing in mind the higher occlusion rate and longevity of the surgical treatment.
通过引入新技术，血管内技术的能力仍在不断扩展。然而，前交通动脉（ACoA）仍是血管内介入治疗后动脉瘤（AN）再生长倾向较高的区域。本研究的目的是强调显微外科治疗的持续重要性。作者对2000年1月至2016年12月间采用“以弹簧圈为主”策略治疗的ACoA AN进行了单机构回顾性研究。结果结合了对文献的系统综述。共有398例连续患者（207例女性，191例男性）的398个ACoA AN接受了治疗。79例AN患者（54例破裂，25例未破裂）接受了显微外科治疗，319例AN患者（250例破裂，69例未破裂）接受了弹簧圈栓塞术。未破裂AN的治疗相关发病率和死亡率（MM）在显微外科组为0%，在血管内组为1.5%（p = 1.000）。蛛网膜下腔出血后无永久性或轻度永久性神经功能缺损的患者比例在显微外科组为74%，在血管内组为70%（p = 0.693）。显微外科组的再治疗率为3.8%，血管内组为9.2%（p = 0.883）。文献综述确定了39项关于ACoA AN治疗的研究。两种治疗方式的临床结果具有可比性，显微外科在影像学结果方面更具优势。本研究表明，两种治疗技术给患者带来的临床益处相当。显微外科在影像学结果方面似乎更具优势。治疗策略的决定应由两个团队的专家组成的多学科团队做出，同时要考虑到手术治疗的更高闭塞率和持久性。
