Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy.
World Neurosurg. 2021 Feb;146:e1293-e1300. doi: 10.1016/j.wneu.2020.11.150. Epub 2020 Dec 5.
In our institution, standard pterional craniotomy (PC) with an extended Sylvian fissure opening (ESFO) represented the standard approach for unruptured middle cerebral artery (MCA) aneurysm clipping until 2014, when we progressively started to prefer minipterional craniotomy (MPC) associated with a focused Sylvian fissure opening (FSFO). In the present study, we compared our results in terms of the efficacy of clipping and the rate of complications with these 2 different techniques.
We included patients with small- and medium-size unruptured MCA aneurysms from January 2008 to December 2018 with follow-up of >12 months. The clinical and radiologic data were reviewed from the medical records. The outcomes were measured in terms of efficacy (aneurysmal exclusion rate) and safety (intracranial complication rate).
Overall, 134 patients who had presented with unruptured MCA aneurysms <1.5 cm were treated at our institution from January 2007 to December 2018: PC and ESFO were used in 73 patients and MPC and FSFO in 61. The demographics and angioarchitectural features were comparable between the 2 groups, except for age, which was older in the FSFO group. The aneurysm exclusion rate was not different between the 2 groups. The intracranial complication rate was, overall, significantly lower in the FSFO group (P < 0.001), especially for the rate of postoperative seizures. Finally, the FSFO group had had shorter postoperative hospitalization and better short- and long-term clinical outcomes.
The association between MPC and FSFO should represent the standard of treatment of unruptured MCA aneurysms in all referral cerebrovascular centers, allowing for the achievement of the same efficacy of standard PC with ESFO and minimizing the complications.
在我们的机构中，标准翼点开颅术（PC）伴扩大的外侧裂开放（ESFO）一直是未破裂大脑中动脉（MCA）动脉瘤夹闭的标准入路，直到 2014 年，我们开始逐渐倾向于使用迷你翼点开颅术（MPC）伴集中的外侧裂开放（FSFO）。在本研究中，我们比较了这两种不同技术在夹闭效果和并发症发生率方面的结果。
我们纳入了 2008 年 1 月至 2018 年 12 月期间接受治疗的伴有小型和中型未破裂 MCA 动脉瘤的患者，随访时间>12 个月。我们从病历中回顾了临床和影像学数据。根据疗效（动脉瘤排除率）和安全性（颅内并发症发生率）来评估结果。
总体而言，我们机构从 2007 年 1 月至 2018 年 12 月治疗了 134 名患有<1.5cm 未破裂 MCA 动脉瘤的患者：73 名患者采用 PC 和 ESFO，61 名患者采用 MPC 和 FSFO。两组患者的人口统计学和血管解剖特征相似，但 FSFO 组的年龄较大。两组患者的动脉瘤排除率无差异。FSFO 组的颅内并发症发生率总体明显较低（P<0.001），尤其是术后癫痫发作的发生率。最后，FSFO 组的术后住院时间更短，短期和长期临床结局更好。
MPC 联合 FSFO 应成为所有转诊脑血管中心治疗未破裂 MCA 动脉瘤的标准治疗方法，既能达到标准 PC 伴 ESFO 的相同疗效，又能最大限度地减少并发症。
