Goertz Lukas, Kabbasch Christoph, Borggrefe Jan, Hamisch Christina, Telentschak Sergej, von Spreckelsen Niklas, Stavrinou Pantelis, Timmer Marco, Brinker Gerrit, Goldbrunner Roland, Krischek Boris
Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany.
Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany.
World Neurosurg. 2018 Dec;120:e1163-e1170. doi: 10.1016/j.wneu.2018.09.026. Epub 2018 Sep 12.
Microsurgical clipping of aneurysms demands precise spatial understanding of aneurysm morphology and vascular geometry. We analyzed the impact of preoperative three-dimensional (3D) angiographic imaging on clinical and angiographic outcome after clipping of ruptured intracranial aneurysms.
This is a retrospective analysis of consecutive patients who underwent microsurgical clipping during the acute phase of subarachnoid hemorrhage between 2010 and 2017. Surgical planning was made based on two-dimensional (2D) or 3D angiographic images. We retrospectively compared complication rates, morbidity, and angiographic outcome between these 2 groups.
A total of 157 patients (mean age: 54.8 ± 13.1 years) were included in the study. Preoperative 3D angiographic imaging was available for 117 cases. The rate of procedure-related ischemia was significantly lower in the 3D group (16.2%) than in the 2D group (35.0%; P = 0.013). In the multivariate analysis, 2D imaging alone remained as independent factor for subsequent brain ischemia (odds ratio: 2.8, 95% confidence interval 1.2-6.6; P = 0.018). Favorable outcome (modified Rankin scale ≤2) was more often attained in the 3D group (70.0%) than in the 2D group (41.9%; P = 0.002). The rate of complete aneurysm occlusion was not significantly different between the 2 groups (P = 0.967).
In our study, accurate operation planning using 3D angiography was associated with a lower ischemic complication rate after clipping of ruptured intracranial aneurysms, which may potentially influence clinical outcome.
颅内动脉瘤显微夹闭术需要对动脉瘤形态和血管几何结构有精确的空间理解。我们分析了术前三维（3D）血管造影成像对破裂颅内动脉瘤夹闭术后临床及血管造影结果的影响。
这是一项对2010年至2017年蛛网膜下腔出血急性期接受显微夹闭术的连续患者的回顾性分析。手术规划基于二维（2D）或3D血管造影图像。我们回顾性比较了这两组的并发症发生率、发病率和血管造影结果。
共有157例患者（平均年龄：54.8±13.1岁）纳入研究。117例患者有术前3D血管造影成像。3D组手术相关缺血发生率（16.2%）显著低于2D组（35.0%；P = 0.013）。多因素分析中，单纯2D成像仍是后续脑缺血的独立因素（比值比：2.8，95%置信区间1.2 - 6.6；P = 0.018）。3D组更常获得良好结局（改良Rankin量表≤2）（70.0%），高于2D组（41.9%；P = 0.002）。两组间动脉瘤完全闭塞率无显著差异（P = 0.967）。
在我们的研究中，使用3D血管造影进行精确的手术规划与破裂颅内动脉瘤夹闭术后较低的缺血并发症发生率相关，这可能潜在影响临床结局。
