Department of Neurological Surgery, University of California, San Francisco, CA, USA.
Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
Acta Neurochir (Wien). 2021 May;163(5):1527-1540. doi: 10.1007/s00701-021-04803-5. Epub 2021 Mar 10.
Currently, most basilar artery aneurysms (BAAs) are treated endovascularly. Surgery remains an appropriate therapy for a subset of all intracranial aneurysms. Whether open microsurgery would be required or utilized, and to what extent, for BAAs treated by a surgeon who performs both endovascular and open procedures has not been reported.
Retrospective analysis of prospectively maintained, single-surgeon series of BAAs treated with endovascular or open surgery from the first 5 years of practice.
Forty-two procedures were performed in 34 patients to treat BAAs-including aneurysms arising from basilar artery apex, trunk, and perforators. Unruptured BAAs accounted for 35/42 cases (83.3%), and the mean aneurysm diameter was 8.4 ± 5.4 mm. Endovascular coiling-including stent-assisted coiling-accounted for 26/42 (61.9%) treatments and led to complete obliteration in 76.9% of cases. Four patients in the endovascular cohort required re-treatment. Surgical clip reconstruction accounted for 16/42 (38.1%) treatments and led to complete obliteration in 88.5% of cases. Good neurologic outcome (mRS ≤ 2) was achieved in 88.5% and 75.0% of patients in endovascular and open surgical cohorts, respectively (p = 0.40). Univariate logistic regression analysis demonstrated that advanced age (OR 1.11[95% CI 1.01-1.23]) or peri-procedural adverse event (OR 85.0 [95% CI 6.5-118.9]), but not treatment modality (OR 0.39[95% CI 0.08-2.04]), was the predictor of poor neurologic outcome.
Complementary implementation of both endovascular and open surgery facilitates individualized treatment planning of BAAs. By leveraging strengths of both techniques, equivalent clinical outcomes and technical proficiency may be achieved with both modalities.
目前，大多数基底动脉动脉瘤（BAAs）采用血管内治疗。对于颅内动脉瘤的一部分患者，手术仍然是一种合适的治疗方法。对于一位同时进行血管内和开放手术的外科医生来说，是否需要或使用开放显微手术，以及在何种程度上需要，目前尚未报道。
对一位外科医生在其执业的前 5 年期间采用血管内或开放手术治疗的基底动脉动脉瘤前瞻性系列病例进行回顾性分析。
共对 34 名患者的 42 例基底动脉动脉瘤进行了治疗，包括基底动脉尖、干和穿支动脉处的动脉瘤。未破裂的 BAAs 占 35/42 例（83.3%），平均动脉瘤直径为 8.4±5.4mm。血管内弹簧圈栓塞术-包括支架辅助弹簧圈栓塞术-占 26/42 例（61.9%），76.9%的病例完全闭塞。血管内治疗组中有 4 例需要再次治疗。外科夹闭重建占 16/42 例（38.1%），88.5%的病例完全闭塞。血管内和开放手术组的患者神经功能良好（mRS≤2）分别为 88.5%和 75.0%（p=0.40）。单变量逻辑回归分析表明，高龄（OR 1.11[95%CI 1.01-1.23]）或围手术期不良事件（OR 85.0[95%CI 6.5-118.9]），但不是治疗方式（OR 0.39[95%CI 0.08-2.04]），是不良神经结局的预测因素。
血管内和开放手术的互补实施有助于个体化治疗基底动脉动脉瘤。通过利用两种技术的优势，两种技术都可能获得同等的临床效果和技术水平。
