Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany.
Sci Rep. 2021 Mar 2;11(1):4982. doi: 10.1038/s41598-021-84339-x.
To clip or coil has been matter of debates for several years and is the domain of interdisciplinary decision making. However, the microsurgical outcome has still been elusive concerning wide neck aneurysms (WNA). A retrospective single center study was performed with all patients with ruptured WNA (rWNA) and unruptured WNA (uWNA) admitted to author´s institute between 2007-2017. Microsurgical outcome was evaluated according to Raymond-Roy occlusion grade and follow-up angiography was performed to analyze the stability of neck/aneurysm remnants and retreatment poverty. Of 805 aneurysms, 139 were rWNA (17.3%) and 148 uWNA (18.4%). Complete occlusion was achieved in 102 of 139 rWNA (73.4%) and 112 of 148 uWNA (75.6%). Neck remnants were observed in 36 patients with rWNA (25.9%) and 30 patients with uWNA (20.3%), 1 (0.7%) and 6 (4.1%) patients had aneurysmal remnant, respectively. Overall complication rate was 11.5%. At follow-up (939/1504 months), all remnants were stable except for one, which was further conservatively treated with marginal retreatment rate under 1%. Even the risk of de-novo aneurysm was higher than the risk for remnant growth (2.6% vs 0% in rWNA; 8.7% vs 5.3% in uWNA) without significant difference. Microsurgical clipping is effective for complete occlusion of r/uWNA with low complication. Furthermore, the risk of remnant growth is marginal even lower than the risk of de-novo rate low retreatment rate.
夹闭或圈闭一直是多年来争论的问题，也是跨学科决策的领域。然而，对于宽颈动脉瘤（WNA），显微外科手术结果仍然难以捉摸。对 2007 年至 2017 年间作者所在机构收治的所有破裂性宽颈动脉瘤（rWNA）和未破裂性宽颈动脉瘤（uWNA）患者进行了回顾性单中心研究。根据 Raymond-Roy 闭塞分级评估显微外科手术结果，并进行随访血管造影以分析颈部/动脉瘤残端的稳定性和再次治疗的贫困。在 805 个动脉瘤中，139 个为 rWNA（17.3%），148 个为 uWNA（18.4%）。139 个 rWNA 中有 102 个（73.4%）和 148 个 uWNA 中有 112 个（75.6%）完全闭塞。36 例 rWNA 患者有颈部残端（25.9%），30 例 uWNA 患者有颈部残端（20.3%），1 例（0.7%）和 6 例（4.1%）患者有动脉瘤残端。总体并发症发生率为 11.5%。在随访（939/1504 个月）中，除 1 例外，所有残端均稳定，该例进一步采用保守治疗，再次治疗率低于 1%。即使新发性动脉瘤的风险高于残留生长的风险（rWNA 为 2.6%比 0%；uWNA 为 8.7%比 5.3%），但差异无统计学意义。显微外科夹闭术对 r/uWNA 的完全闭塞有效，且并发症发生率低。此外，即使残留生长的风险较低，也低于新发性动脉瘤的风险，再次治疗率也较低。
