1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.
2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland.
Neurosurg Focus. 2021 Nov;51(5):E10. doi: 10.3171/2021.8.FOCUS20892.
Microsurgery plays an essential role in managing unruptured intracranial aneurysms (UIAs). The Clavien-Dindo classification is a therapy-oriented grading system that rates any deviation from the normal postoperative course in five grades. In this study, the authors aimed to test the applicability of the Clavien-Dindo grade (CDG) in patients who underwent microsurgical treatment of UIAs.
The records of patients who underwent microsurgery for UIAs (January 2013-November 2018) were retrieved from a prospective database. Complications at discharge and at short-term follow-up (3 months) were rated according to the Clavien-Dindo system. Patient outcomes were graded using the modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). A descriptive statistic was used for data analysis.
Overall, 156 patients underwent 157 surgeries for 201 UIAs (size range 4-42 mm). Thirty-nine patients (25%) had complex UIAs. An adverse event (CDG ≥ I) occurred in 21 patients (13.5%) by the time of discharge. Among these, 10 patients (6.4%) presented with a new neurological deficit. Significant correlations existed between a CDG ≥ I and an increase in mRS and NIHSS scores (p < 0.001). Patients treated for complex aneurysms had a significantly higher risk of developing new neurological deficits (20.5% vs 1.7%, p = 0.007). At the 3-month follow-up, a CDG ≥ I was registered in 16 patients (10.3%); none presented with a new neurological deficit. A CDG ≥ I was associated with a longer hospital length of stay (LOS) (no complication vs CDG ≥ I, 6.2 ± 3.5 days vs 9.3 ± 7.7 days, p = 0.02).
The CDG was applicable to patients who received microsurgery of UIAs. A significant correlation existed between CDG and outcome scales, as well as LOS. The aneurysm complexity was significantly associated with a higher risk for new neurological deficit.
显微手术在处理未破裂颅内动脉瘤（UIAs）中起着至关重要的作用。Clavien-Dindo 分类是一种以治疗为导向的分级系统，将术后任何偏离正常病程的情况分为五个等级。在这项研究中，作者旨在测试 Clavien-Dindo 分级（CDG）在接受 UIAs 显微手术治疗的患者中的适用性。
从一个前瞻性数据库中检索了 2013 年 1 月至 2018 年 11 月接受 UIAs 显微手术的患者记录。根据 Clavien-Dindo 系统对出院时和短期随访（3 个月）时的并发症进行评分。采用改良 Rankin 量表（mRS）和美国国立卫生研究院卒中量表（NIHSS）对患者结局进行分级。采用描述性统计对数据进行分析。
共有 156 名患者接受了 157 次手术治疗 201 个 UIAs（大小范围 4-42mm）。39 名患者（25%）存在复杂的 UIAs。21 名患者（13.5%）在出院时发生不良事件（CDG≥I）。其中，10 名患者（6.4%）出现新的神经功能缺损。CDG≥I 与 mRS 和 NIHSS 评分升高之间存在显著相关性（p<0.001）。接受复杂动脉瘤治疗的患者发生新的神经功能缺损的风险显著增加（20.5%vs1.7%，p=0.007）。在 3 个月随访时，16 名患者（10.3%）出现 CDG≥I；均无新发神经功能缺损。CDG≥I 与住院时间延长（无并发症与 CDG≥I，6.2±3.5 天与 9.3±7.7 天，p=0.02）相关。
CDG 适用于接受 UIAs 显微手术治疗的患者。CDG 与结局量表和 LOS 之间存在显著相关性。动脉瘤的复杂性与新的神经功能缺损风险显著相关。
