Department of Neurosurgery.
Department of Neurologic Endovascular Therapy. Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.
Cir Cir. 2022;90(S1):84-91. doi: 10.24875/CIRU.21000682.
We aimed to compare outcomes of patients with middle cerebral artery (MCA) aneurysms treated by either microsurgical clipping or endovascular therapy and provide a treatment algorithm based on available evidence.
We performed a retrospective analysis of 77 patients with 95 MCA aneurysms. Demographic, clinical, and aneurysm morphological variables were collected. Patients were divided into two groups depending on the received treatment. Clinical and radiological outcomes were collected at the end of a 1-year follow-up period and compared between both treatment groups.
Mean age was 51.4 years. Fifty patients (65%) underwent microsurgical clipping and 27 (35%) were treated by endovascular therapy. Fifty-four patients (70%) presented with subarachnoid hemorrhage, while 23 (30%) were treated for unruptured aneurysms. Patients with subarachnoid hemorrhage were more frequently treated by microsurgical clipping than patients with unruptured aneurysms. Clinical outcomes, including functional status, were similar between treatment groups after 1-year follow-up even when adjusting for clinical presentation. Residual aneurysms were found less frequently in the microsurgical group (OR = 0.09; p < 0.001).
In patients with MCA aneurysms, clinical outcomes at 1 year are similar between microsurgical clipping and endovascular therapy. However, microsurgery is associated with a lower risk of residual aneurysms.
我们旨在比较接受显微夹闭术或血管内治疗的大脑中动脉（MCA）动脉瘤患者的结局，并根据现有证据提供治疗算法。
我们对 77 例 95 个 MCA 动脉瘤患者进行了回顾性分析。收集了人口统计学、临床和动脉瘤形态学变量。根据所接受的治疗将患者分为两组。在 1 年随访结束时收集临床和影像学结局，并在两组之间进行比较。
平均年龄为 51.4 岁。50 例（65%）患者接受了显微夹闭术，27 例（35%）患者接受了血管内治疗。54 例（70%）患者出现蛛网膜下腔出血，23 例（30%）患者为未破裂动脉瘤。蛛网膜下腔出血患者比未破裂动脉瘤患者更常接受显微夹闭术治疗。即使在调整临床表现后，两组患者在 1 年随访后的功能状态等临床结局相似。显微外科组残留动脉瘤的发生率较低（OR=0.09；p<0.001）。
在 MCA 动脉瘤患者中，显微夹闭术和血管内治疗的 1 年临床结局相似。然而，显微手术与残留动脉瘤的风险较低相关。
