Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Acta Neurochir Suppl. 2021;132:47-53. doi: 10.1007/978-3-030-63453-7_7.
The advent of flow diverter (FD) stents has apparently reduced the role of microneurosurgery for paraclinoid aneurysms despite sparse high-quality evidence about their long-term effects.The present study critically reviews the overall results of a microneurosurgical series of 57 paraclinoid aneurysms.Of these aneurysms, 47.4% were regular in size while 19.3 were giant. Barami type I was predominant. In 21 aneurysms a hemorrhagic onset occurred. Pterional approach with intradural anterior clinoidectomy was preferred by far. Clipping was possible in 91.2% of aneurysms and a high-flow bypass was the choice in five cases. An mRS of 0-2 was achieved in 77.3% of patients, typically <50 years old.Visual field appeared improved or unchanged in 36.3% and 63.6% of the symptomatic patients, respectively. In 76.1% of incidental aneurysms, campimetry was unaffected by surgery.A complete aneurysm exclusion was achieved in 93% of cases using a single procedure. No recurrences were documented on an average follow-up of 54.1 ± 34 months.Microneurosurgery is still a valuable, definitive, and durable option for Barami type Ia, Ib, or II paraclinoid aneurysm, especially in patients <50 years old and visually symptomatic. Conditions other than these are ideal candidates for FD stents.
尽管关于血流导向装置（FD）支架长期效果的高质量证据有限，但它的出现显然降低了神经外科手术夹闭在治疗颅底-眶尖部动脉瘤中的作用。本研究对一组 57 例经显微神经外科治疗的颅底-眶尖部动脉瘤的总体结果进行了批判性评估。这些动脉瘤中，47.4%为规则大小，19.3%为巨大动脉瘤。Barami ⅠA型最为常见。21 例动脉瘤为出血性起病。翼点入路联合硬膜内前床突切除术是目前首选的手术入路。91.2%的动脉瘤可以夹闭，5 例采用高流量旁路。77.3%的患者改良 Rankin 量表（mRS）评分为 0-2 分，典型的年龄<50 岁。36.3%和 63.6%的有症状患者视野分别改善或无变化。76.1%的偶然发现的动脉瘤，手术对视野计检查无影响。93%的患者通过单次手术即可实现完全动脉瘤闭塞。平均随访 54.1±34 个月，无复发。对于 Barami ⅠA型、ⅠB 型或Ⅱ型颅底-眶尖部动脉瘤，特别是年龄<50 岁且视力有症状的患者，显微神经外科手术仍然是一种有价值的、确定性的和持久的选择。对于其他情况，FD 支架是理想的选择。
