Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
World Neurosurg. 2020 Jun;138:e289-e298. doi: 10.1016/j.wneu.2020.02.099. Epub 2020 Feb 26.
Minimally invasive craniotomy (MIC) for ruptured aneurysm remains a debatable issue because of unclear information regarding its safety and efficacy compared with standard approaches. Here, we compared the outcomes between MIC and pterional craniotomy (PTC) for the treatment of ruptured anterior circulation aneurysms.
A database of patients with ruptured anterior circulation aneurysm who were treated with surgical clipping was reviewed. With the use of propensity score matching to balance the baseline characteristics of MIC and PTC groups, outcomes of the 2 groups were compared. Clinical predictors of favorable outcomes (modified Rankin scale score 0-2) were evaluated by using uni- and multivariate analyses.
A total of 102 matched pairs were identified. MIC resulted in a significantly shorter operative time (2.8 ± 0.9 vs. 4.2 ± 0.7 hours; P = 0.004) and hospital stay (14.2 ± 5.9 vs. 19.2 ± 9.1 days; P < 0.001), respectively. Both MIC and PTC had similar mortality and complication rates except for the incidences of intracranial hemorrhage (2% vs. 9.8%; P = 0.039) and brain injury (9.8% vs. 27.5%; P = 0.036), respectively. Use of MIC instead of standard surgery and lower World Federation of Neurosurgical Societies (WFNS) grade and absence of hydrocephalus were significant predictors of favorable outcome at 1 month, whereas higher WFNS grade and higher Fisher grade were significantly associated with a poor outcome at 6 months.
For the treatment of ruptured anterior circulation aneurysms, MIC was comparable with PTC and presented additional advantage in terms of earlier recovery. Therefore, MIC can be considered an alternative surgical treatment in this setting.
与标准方法相比，微创开颅术（MIC）治疗破裂的动脉瘤的安全性和疗效仍存在争议，因为其相关信息尚不清楚。在此，我们比较了 MIC 和翼点入路开颅术（PTC）治疗破裂的前循环动脉瘤的结果。
我们回顾了接受手术夹闭治疗的破裂前循环动脉瘤患者的数据库。通过使用倾向评分匹配来平衡 MIC 和 PTC 组的基线特征，比较了两组的结果。使用单因素和多因素分析评估了临床预测因素（改良 Rankin 量表评分 0-2）。
共确定了 102 对匹配对。MIC 组的手术时间（2.8 ± 0.9 小时 vs. 4.2 ± 0.7 小时；P = 0.004）和住院时间（14.2 ± 5.9 天 vs. 19.2 ± 9.1 天；P < 0.001）分别明显缩短。MIC 和 PTC 的死亡率和并发症发生率相似，但颅内出血的发生率（2% vs. 9.8%；P = 0.039）和脑损伤的发生率（9.8% vs. 27.5%；P = 0.036）不同。使用 MIC 而不是标准手术以及较低的世界神经外科学会（WFNS）分级和无脑积水是 1 个月时良好预后的显著预测因素，而较高的 WFNS 分级和较高的 Fisher 分级与 6 个月时不良预后显著相关。
对于破裂的前循环动脉瘤的治疗，MIC 与 PTC 相当，并且在恢复方面具有额外的优势。因此，MIC 可以被认为是该治疗环境中的一种替代手术治疗方法。
