Güresir Erdem, Wispel Christian, Borger Valeri, Hadjiathanasiou Alexis, Vatter Hartmut, Schuss Patrick
Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
World Neurosurg. 2018 Oct;118:e834-e841. doi: 10.1016/j.wneu.2018.07.063. Epub 2018 Jul 17.
Partially thrombosed intracranial aneurysms (PTIAs) represent a challenging subgroup of aneurysms, with an organized intraluminal thrombus and a solid mass, in which the optimal therapeutic strategy is discussed controversially because of limited data. We therefore analyzed the results of surgical and endovascular treatment in patients with PTIAs treated in our department and combined the results with a systematic literature review.
Between January 2006 and October 2016, data from 996 patients with intracranial aneurysms were prospectively entered into a database. Twenty-five consecutive patients harbored PTIAs and were treated in the authors' institution. The degree of aneurysm occlusion, the degree of recurrence, and the necessity of aneurysm retreatment were assessed and analyzed. PubMed was searched for published studies of PTIAs to gain a larger population. Multivariate regression models were performed on the pooled data.
Literature data, including the present series, revealed a total of 157 patients. Overall, 64 patients (41%) were treated by clipping, and 93 patients (59%) were treated by endovascular treatment. In the multivariate analysis, surgical treatment of PTIAs was an independent predictor for complete aneurysm occlusion (P < 0.001). In a second multivariate model, endovascular treatment was independently associated with aneurysm recurrence (P < 0.001). In a third multivariate model, endovascular treatment was associated with a higher rate of retreatment (P < 0.001).
In this study, surgical treatment of PTIAs showed superior initial radiologic results and better long-term stability than endovascular treatment. Therefore, surgical treatment should be considered in those patients harboring PTIAs who are qualified as suitable surgical candidates after interdisciplinary consensus.
部分血栓形成的颅内动脉瘤（PTIA）是一类具有挑战性的动脉瘤亚组，其管腔内有组织化血栓和实体肿块，由于数据有限，关于其最佳治疗策略存在争议。因此，我们分析了在我院接受治疗的PTIA患者的手术和血管内治疗结果，并将结果与系统的文献综述相结合。
2006年1月至2016年10月期间，前瞻性地将996例颅内动脉瘤患者的数据录入数据库。连续25例患者患有PTIA并在作者所在机构接受治疗。评估并分析动脉瘤闭塞程度、复发程度以及动脉瘤再次治疗的必要性。检索PubMed上发表的关于PTIA的研究以纳入更多患者。对汇总数据进行多变量回归模型分析。
包括本系列研究在内的文献数据共纳入157例患者。总体而言，64例患者（41%）接受了夹闭治疗，93例患者（59%）接受了血管内治疗。在多变量分析中，PTIA的手术治疗是动脉瘤完全闭塞的独立预测因素（P < 0.001）。在第二个多变量模型中，血管内治疗与动脉瘤复发独立相关（P < 0.001）。在第三个多变量模型中，血管内治疗与更高的再次治疗率相关（P < 0.001）。
在本研究中，PTIA的手术治疗在初始影像学结果和长期稳定性方面均优于血管内治疗。因此，对于那些经过多学科共识评估后适合手术的PTIA患者，应考虑手术治疗。
