Luzzi Sabino, Del Maestro Mattia, Galzio Renato
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
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（FD）支架长期效果的高质量证据稀少，但它的出现显然降低了显微神经外科手术治疗床突旁动脉瘤的作用。本研究批判性地回顾了一组57例床突旁动脉瘤显微神经外科手术的总体结果。在这些动脉瘤中，47.4%大小正常，19.3%为巨大型。I型Barami型为主。21例动脉瘤有出血性起病。目前翼点入路联合硬膜内前床突切除术是首选。91.2%的动脉瘤可以夹闭，5例选择高流量搭桥。77.3%的患者改良Rankin量表（mRS）评分为0 - 2分，这些患者通常年龄小于50岁。有症状患者中，分别有36.3%和63.6%的视野改善或未改变。76.1%的偶然发现的动脉瘤，视野检查未受手术影响。93%的病例通过单次手术实现了动脉瘤完全排除。平均随访54.1±34个月，未记录到复发。对于Ia、Ib或II型Barami型床突旁动脉瘤，显微神经外科手术仍然是一种有价值、确定性和持久性的选择，特别是对于年龄小于50岁且有视觉症状的患者。除此之外的情况是FD支架的理想适应证。
