Kosty J A, Andaluz N O, Gozal Y M, Krueger B M, Scoville J, Zuccarello M
a Department of Neurosurgery , University of Louisville , Louisville , KY , USA.
b Department of Neurosurgery , University of Cincinnati Medical Center , Cincinnati , OH , USA.
Br J Neurosurg. 2019 Jun;33(3):322-327. doi: 10.1080/02688697.2018.1527286. Epub 2018 Nov 19.
With the rise of endovascular treatments for the management of unruptured intracranial aneurysms (UIAs), advances in microsurgical techniques are underrepresented in modern surgical series, which largely consist of patients with aneurysms unfit for coiling. We report a modern series of microsurgical treatment for UIAs performed by a single surgeon as the preferred treatment modality. We retrospectively reviewed the charts of all patients with UIAs treated by the senior author with microsurgical clipping over an 11-year period. Procedure-related mortality, major neurologic morbidity (modified Rankin Score 3-5), complications, and persistent neurologic deficits were recorded. Risk factors for persistent neurologic deficits and major morbidity or mortality were analyzed using multivariate logistic regression analysis. We identified 329 patients with 400 UIAs treated in 353 surgeries. The average age was 52 years, 80% of patients were women, and 13% had a previous subarachnoid hemorrhage. The average aneurysm size was 7 mm and 92% were in the anterior circulation. The mean follow-up was 15 months (range 0.5-125). There was one procedure-related death (0.3%), and two patients suffered major morbidity (0.6%). Twenty procedures (5.6%) resulted in a persistent neurologic deficit. Risk factors for death and major morbidity were increasing age and posterior circulation, while risk factors for persistent neurologic deficits were increasing aneurysm size and posterior circulation. We conclude that microsurgical clipping is safe, effective, and should be given strong consideration as the primary treatment modality for younger patients with small to medium sized UIAs in the anterior circulation.
随着颅内未破裂动脉瘤（UIA）血管内治疗的兴起，现代外科手术系列中显微外科技术的进展未得到充分体现，这些系列主要包括不适合进行血管内栓塞的动脉瘤患者。我们报告了由一位外科医生将显微外科手术作为首选治疗方式对UIA进行治疗的现代系列病例。我们回顾性分析了资深作者在11年期间采用显微外科夹闭术治疗的所有UIA患者的病历。记录了与手术相关的死亡率、严重神经功能障碍（改良Rankin评分3 - 5分）、并发症以及持续性神经功能缺损情况。使用多因素逻辑回归分析来分析持续性神经功能缺损以及严重发病或死亡的危险因素。我们确定了329例患者，共400个UIA，进行了353次手术。患者平均年龄为52岁，80%为女性，13%曾有蛛网膜下腔出血病史。动脉瘤平均大小为7毫米，92%位于前循环。平均随访时间为15个月（范围0.5 - 125个月）。有1例与手术相关的死亡（0.3%），2例患者出现严重并发症（0.6%）。20例手术（5.6%）导致持续性神经功能缺损。死亡和严重并发症的危险因素是年龄增加和后循环动脉瘤，而持续性神经功能缺损的危险因素是动脉瘤大小增加和后循环动脉瘤。我们得出结论，显微外科夹闭术是安全、有效的，对于前循环中小型UIA的年轻患者，应强烈考虑将其作为主要治疗方式。
