Park Jun Sang, Kim Hoon, Baik Min Woo, Park Ik Seong
Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
World Neurosurg. 2018 Mar;111:e386-e394. doi: 10.1016/j.wneu.2017.12.071. Epub 2017 Dec 20.
The transciliary keyhole approach has been actively employed for unruptured intracranial aneurysms in many institutions, although applying this technique to ruptured aneurysms remains controversial. We investigated risk factors related to poor surgical outcomes in ruptured aneurysms and attempted to clarify the differences between conventional craniotomy and keyhole surgery.
A retrospective review was performed at a single institution of medical records and images from surgeries of 188 patients who underwent keyhole surgery for ruptured anterior circulation aneurysms between July 2007 and February 2015.
The study included 116 (62%) female and 72 (38%) male patients; age range was 23-86 years. Preoperative clinical grades were good in almost all patients except for a few patients with poor clinical grades. Mean aneurysm size was 5.5 mm, and the most common aneurysm location was the anterior communicating artery (n = 82). Most patients (n = 158; 91.5%) showed good clinical outcomes. Univariate analysis of risk factors associated with poor-grade outcomes after 3 months was performed. Hunt and Hess grade (odds ratio [OR] 13.50, P < 0.0001), World Federation of Neurosurgical Societies scale (OR 7.69, P < 0.0001), aneurysm size (OR 1.21, P = 0.019), and vasospasm (OR 6.43, P = 0.0003) were statistically significant, whereas Fisher grade, skin-to-skin time (operation time), rebleeding, and ventricle puncture were not statistically significant.
Because incidence of poor surgical outcome of keyhole surgery is not different from known conventional craniotomy, this approach is an acceptable treatment option in a good-grade ruptured anterior circulation aneurysm.
经睫状体锁孔入路已在许多机构积极应用于未破裂颅内动脉瘤，尽管将该技术应用于破裂动脉瘤仍存在争议。我们调查了破裂动脉瘤手术效果不佳的相关危险因素，并试图阐明传统开颅手术与锁孔手术之间的差异。
对2007年7月至2015年2月期间在单一机构接受锁孔手术治疗破裂前循环动脉瘤的188例患者的病历和影像进行回顾性研究。
该研究包括116例（62%）女性和72例（38%）男性患者；年龄范围为23 - 86岁。除少数临床分级较差的患者外，几乎所有患者术前临床分级良好。动脉瘤平均大小为5.5 mm，最常见的动脉瘤位置是前交通动脉（n = 82）。大多数患者（n = 158；91.5%）临床结局良好。对3个月后不良分级结局相关危险因素进行单因素分析。Hunt和Hess分级（比值比[OR] 13.50，P < 0.0001）、世界神经外科协会联盟量表（OR 7.69，P < 0.0001）、动脉瘤大小（OR 1.21，P = 0.019）和血管痉挛（OR 6.43，P = 0.0003）具有统计学意义，而Fisher分级、皮肤到皮肤时间（手术时间）、再出血和脑室穿刺无统计学意义。
由于锁孔手术不良手术结局的发生率与已知的传统开颅手术无异，因此该入路是治疗分级良好的破裂前循环动脉瘤的可接受治疗选择。
