Department of Neurosurgery, National Brain Aneurysm and Tumor Center, United Hospital, 3033 Excelsior Boulevard, Suite 495, Minneapolis, MN, USA.
Superior Medical Experts, St. Paul, MN, USA.
Acta Neurochir (Wien). 2022 Feb;164(2):525-535. doi: 10.1007/s00701-021-04996-9. Epub 2021 Sep 25.
With the growing use of endovascular therapy (EVT) to manage unruptured intracranial aneurysms (IAs), detailed information regarding periprocedural complication rates of microsurgical clipping and EVT becomes increasingly important in determining the optimal treatment for individual cases. We report the complication rates associated with open microsurgery in a large series of unruptured IAs and highlight the importance of maintaining surgical skill in the EVT era.
We reviewed all cases of unruptured IAs treated with open microsurgery by a single neurosurgeon between July 1997 and June 2019. We analyzed surgical complications, deaths, and patient-reported outcomes.
A total of 1923 unruptured IAs in 1750 patients (mean age 44 [range: 6-84], 62.0% [1085/1750] female) were treated surgically during the study period. Of the aneurysms treated, 84.9% (1632/1923) were small, 11.1% (213/1923) were large, and 4.1% (78/1923) were giant. Aneurysm locations included the middle cerebral artery (44.2% [850/1923]), internal carotid artery (29.1% [560/1923]), anterior cerebral artery (21.0% [404/1923]), and vertebrobasilar system (5.7% [109/1923]). The overall mortality rate was 0.3% (5/1750). Surgical complications occurred in 7.4% (129/1750) of patients, but only 0.4% (7/1750) experienced permanent disability. The majority of patients were able to return to their preoperative lifestyles with no modifications (95.9% [1678/1750]).
At a high-volume, multidisciplinary center, open microsurgery in carefully selected patients with unruptured IAs yields favorable clinical outcomes with low complication rates. The improvement of EVT techniques and the ability to refer cases for EVT when a high complication rate with open microsurgery was expected have contributed to an overall decrease in surgical complication rates. These results may serve as a useful point of reference for physicians involved in treatment decision-making for patients with unruptured IAs.
随着血管内治疗（EVT）在未破裂颅内动脉瘤（IA）治疗中的应用日益增多，详细了解显微夹闭术和 EVT 的围手术期并发症发生率对于确定个体化病例的最佳治疗方案变得越来越重要。我们报告了在一项大型未破裂 IA 系列病例中，与开颅显微手术相关的并发症发生率，并强调了在 EVT 时代保持手术技能的重要性。
我们回顾了 1997 年 7 月至 2019 年 6 月期间，由同一位神经外科医生采用开颅显微手术治疗的所有未破裂 IA 病例。我们分析了手术并发症、死亡和患者报告的结局。
在研究期间，共有 1750 例患者（平均年龄 44 岁[范围：6-84 岁]，62.0%[1085/1750]为女性）接受了开颅显微手术治疗的 1923 个未破裂 IA。治疗的动脉瘤中，84.9%（1632/1923）为小型，11.1%（213/1923）为大型，4.1%（78/1923）为巨大型。动脉瘤位置包括大脑中动脉（44.2%[850/1923]）、颈内动脉（29.1%[560/1923]）、大脑前动脉（21.0%[404/1923]）和椎基底动脉系统（5.7%[109/1923]）。总体死亡率为 0.3%（5/1750）。7.4%（129/1750）的患者发生手术并发症，但仅有 0.4%（7/1750）出现永久性残疾。大多数患者无需任何调整即可恢复术前生活方式（95.9%[1678/1750]）。
在高容量、多学科中心，对精心选择的未破裂 IA 患者进行开颅显微手术可获得良好的临床结局，并发症发生率低。EVT 技术的改进，以及当开颅显微手术并发症发生率较高时能够将病例转介至 EVT，这都有助于总体手术并发症发生率的降低。这些结果可以为参与未破裂 IA 患者治疗决策的医生提供有用的参考。
