Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany.
Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Acta Neurochir (Wien). 2018 Nov;160(11):2169-2176. doi: 10.1007/s00701-018-3675-9. Epub 2018 Sep 17.
Complex aneurysm shape is a predominant risk factor for aneurysm rupture but its impact on clinical outcome after clipping remains unclear. The objective of the present study was to compare complications and morbidity after clipping of unruptured single-sac aneurysms (SSAs) and aneurysms with multiple sacs (MSAs).
A retrospective, single-center study was conducted for patients that were treated between 2010 and 2018. We analyzed surgical parameters, treatment-related complications, and morbidity, defined as any increase in the modified Rankin scale at 3-month follow-up.
We identified 101 patients (mean age: 52.9 ± 10.5 years) that underwent clipping for 57 SSAs and 44 MSAs. The two groups were comparable regarding aneurysm size and neck width. Clipping of MSAs was associated with a longer operation time (p = 0.008) and increased use of intraoperative indocyanine green (p = 0.016) than SSAs. Complications occurred more often in the MSA group (29.5%) than in the SSA group (14.0%; p = 0.057). Morbidity was significantly higher in the MSA group (20.5%) than in the SSA group (3.5%, p = 0.009). In the univariate analysis, the odds of morbidity were 7.1 times greater for MSAs than for SSAs (95% CI 1.4-34.7).
Morbidity after microsurgical clipping is significantly increased in MSAs as compared to SSAs. This may be attributed to a more difficult clip placement with stronger manipulation of the aneurysm dome and the surrounding brain tissue.
复杂的动脉瘤形状是动脉瘤破裂的主要危险因素，但它对夹闭后的临床结果的影响尚不清楚。本研究的目的是比较未破裂的单囊动脉瘤（SSA）和多腔动脉瘤（MSA）夹闭后的并发症和发病率。
这是一项回顾性、单中心的研究，纳入了 2010 年至 2018 年期间接受治疗的患者。我们分析了手术参数、与治疗相关的并发症和发病率，定义为 3 个月随访时改良 Rankin 量表评分增加。
我们确定了 101 例患者（平均年龄：52.9±10.5 岁），其中 57 例接受了 SSA 夹闭，44 例接受了 MSA 夹闭。两组在动脉瘤大小和颈部宽度方面具有可比性。MSA 的夹闭与手术时间延长（p=0.008）和术中吲哚菁绿（ICG）使用增加（p=0.016）相关。MSA 组的并发症发生率（29.5%）高于 SSA 组（14.0%；p=0.057）。MSA 组的发病率（20.5%）显著高于 SSA 组（3.5%；p=0.009）。在单因素分析中，MSA 的发病率是 SSA 的 7.1 倍（95%CI 1.4-34.7）。
与 SSA 相比，MSA 显微手术后的发病率显著增加。这可能归因于夹闭时对动脉瘤瘤顶和周围脑组织的更强操作，导致夹闭更困难。
