Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil.
World Neurosurg. 2021 Jul;151:e533-e544. doi: 10.1016/j.wneu.2021.04.079. Epub 2021 Apr 24.
Unruptured intracranial aneurysms (UIAs) are increasingly diagnosed but treatment is still controversial. Although the descriptions and use of minimally invasive surgery (MIS) have increased, comparative studies with standard approaches are rare.
MISIAN (Minimally Invasive Surgery for Treatment of Unruptured Intracranial Aneurysms) is a prospective randomized single-center clinical trial with long-term follow-up comparing different MIS techniques with standard open surgery for treatment of UIAs.
We randomly allocated a standard pterional approach (PtA) or MIS (1:2) to 111 patients with UIAs of the anterior circulation (mean dome diameter, 6.4 mm; range, 3-20 mm). Patients selected for MIS underwent a second randomization between a transeyelid approach (TelA) or nanopterional approach (NPtA) (1:1).
Forty-one patients were randomized to and treated with the PtA, 36 with the TelA, and 34 with the NPtA. Only patients treated with PtA had permanent facial nerve palsy (n = 4 [10%]; P = 0.032). MIS cosmetic results were considered better than those of PtA by independent observers (P < 0.001), and less temporal atrophy in the MIS group was also observed (P = 0.0034). The proportion of excellent results was higher in the TelA group than in the NPtA group (86% vs. 67.6%; P = 0.039). Patients undergoing MIS also reported consistently higher satisfaction and quality-of-life scores (P < 0.001).
MIS is superior to standard PtA for microsurgical clipping of small UIAs of the anterior circulation in terms of cosmetic, satisfaction, and quality-of-life outcomes. The TelA or NPtA for UIAs did not show significant outcome differences at 12-18 months.
未破裂颅内动脉瘤（UIAs）的诊断率逐渐升高，但治疗仍存在争议。虽然微创外科（MIS）的描述和应用有所增加，但与标准方法的比较研究很少。
MISIAN（微创治疗未破裂颅内动脉瘤）是一项前瞻性随机单中心临床试验，长期随访比较了不同 MIS 技术与标准开颅手术治疗 UIAs 的效果。
我们将 111 例前循环 UIAs 患者（平均瘤顶直径 6.4mm；范围 3-20mm）随机分为标准翼点入路（PtA）或 MIS（1:2）组。选择 MIS 的患者在经眼睑入路（TelA）或微翼点入路（NPtA）之间进行二次随机分组（1:1）。
41 例患者随机分为 PtA 组，36 例患者随机分为 TelA 组，34 例患者随机分为 NPtA 组。只有接受 PtA 治疗的患者发生永久性面神经瘫痪（n=4[10%]；P=0.032）。独立观察者认为 MIS 的美容效果优于 PtA（P<0.001），且 MIS 组的颞肌萎缩较少（P=0.0034）。TelA 组的优秀结果比例高于 NPtA 组（86%比 67.6%；P=0.039）。接受 MIS 的患者报告的满意度和生活质量评分也更高（P<0.001）。
在美容、满意度和生活质量方面，MIS 优于标准翼点入路夹闭小型前循环 UIAs。在 12-18 个月时，TelA 或 NPtA 治疗 UIAs 没有显示出显著的结果差异。
