Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Acta Neurochir Suppl. 2021;132:9-17. doi: 10.1007/978-3-030-63453-7_2.
The goal of this survey is to investigate the indications for preoperative digital subtraction angiography (DSA) before clipping of ruptured and unruptured intracranial aneurysms in an international panel of neurovascular specialists.
An anonymous survey of 23 multiple-choice questions relating to indications for DSA before clipping of an intracranial aneurysm was distributed to the international panel of attendees of the European-Japanese Cerebrovascular Congress (EJCVC), which took place in Milan, Italy on 7-9 June 2018. The survey was collected during the same conference. Descriptive statistics were used to analyze the data.
A total of 93 surveys were distributed, and 67 (72%) completed surveys were returned by responders from 13 different countries. Eighty-five percent of all responders were neurosurgeons. For unruptured and ruptured middle cerebral artery (MCA) aneurysms without life-threatening hematoma, approximately 60% of responders perform surgery without preoperative DSA. For aneurysms in other locations than MCA, microsurgery is done without preoperative DSA in 68% of unruptured and in 73% of ruptured cases. In cases of ruptured MCA or ruptured non-MCA aneurysms with life-threatening hematoma, surgery is performed without DSA in 97% and 96% of patients, respectively. Factors which lead to preoperative DSA being performed were: aneurysmal shape (fusiform, dissecting), etiology (infectious), size (>25 mm), possible presence of perforators or efferent vessels arising from the aneurysm, intra-aneurysmal thrombus, previous treatment, location (posterior circulation and paraclinoid aneurysm) and flow-replacement bypass contemplated for final aneurysm treatment. These are all factors that qualify an aneurysm as a complex aneurysm.
There is still a high variability in the surgeons' preoperative workup regarding the indication for DSA before clipping of ruptured and unruptured intracranial aneurysms, except for ruptured aneurysms with life-threatening hematoma. There is a general consensus among cerebrovascular specialists that any angioanatomical feature indicating a complex aneurysm should lead to a more detailed workup including preoperative DSA.
本调查旨在研究国际神经血管专家小组在夹闭破裂和未破裂颅内动脉瘤前进行术前数字减影血管造影（DSA）的适应证。
在 2018 年 6 月 7 日至 9 日于意大利米兰举行的欧洲-日本脑血管大会（EJCVC）国际参会者小组中，匿名调查了 23 个与颅内动脉瘤夹闭前 DSA 适应证相关的多项选择题。该调查在同一场会议期间进行。使用描述性统计数据对数据进行分析。
共发放了 93 份调查，来自 13 个不同国家的 67 名（72%） responder 完成了调查。所有 responder 中 85%为神经外科医生。对于无危及生命血肿的未破裂和破裂大脑中动脉（MCA）动脉瘤，约 60%的 responder 在不进行术前 DSA 的情况下进行手术。对于 MCA 以外部位的动脉瘤，未破裂和破裂病例中分别有 68%和 73%的情况下不进行术前 DSA 进行显微手术。对于破裂 MCA 或破裂伴有危及生命血肿的非 MCA 动脉瘤，分别有 97%和 96%的患者在无 DSA 的情况下进行手术。导致进行术前 DSA 的因素包括：动脉瘤形状（梭形、夹层）、病因（感染性）、大小（>25mm）、可能存在发自动脉瘤的穿支或流出血管、瘤内血栓、既往治疗、位置（后循环和颅底旁动脉瘤）和计划用于最终动脉瘤治疗的血流替代旁路。这些都是将动脉瘤归类为复杂动脉瘤的因素。
除了伴有危及生命血肿的破裂动脉瘤外，在夹闭破裂和未破裂颅内动脉瘤前，外科医生对于 DSA 的术前检查适应证仍存在很大的差异。脑血管专家普遍认为，任何提示复杂动脉瘤的血管解剖特征都应导致更详细的检查，包括术前 DSA。
