Department of Neurosurgery, Trakya University School of Medicine, Trakya University Hospital Trakya University Hospital, 22030 Balkan Campus, Edirne, Turkey.
Neurosurg Rev. 2024 Mar 19;47(1):121. doi: 10.1007/s10143-024-02344-w.
The objective was to provide comprehensive preoperative information on both the aneurysm orientation and the side and method of surgical approach for optimal preoperative information and safe clipping using 3D imaging modalities. This was achieved by making an objective risk assessment on the surgical side/method and evaluating its effectiveness with internal validation.
Radiologic data of 61 ACoA aneurysm patients between 2012 and 2020 were retrospectively analyzed. A scoring system based on five criteria; ACoA aneurysm dome orientation, A1 symmetry/control, perforating artery control, A2 trace orientation, and A2 fork symmetry was developed. The system is designed to align with the most common surgical approaches in ACoA aneurysm surgery. The patients were categorized into three groups based on the scoring results to determine the most appropriate surgical method. Group I was recommended, Group II was less recommended, and Group III was least recommended. Internal validation was performed to assess the system's effectiveness. Outcomes and complication rates were statistically evaluated.
When the scoring system was utilized, the mean score difference between the first group and the other groups was 2.71 and 4.62, respectively. There was a homogeneous distribution among the groups in terms of age, sex, WFNS, and Fisher scores. Complication occurred in three patients in Group I and nine patients each in Group II and Group III. The further the deviation from the first option, the higher the complication rate (p = 0.016), and a significant cause-effect relationship was identified (p = 0.021). The ROC curve established a cut-off value of 12.5 points for complications and outcomes.
Our study introduces a new scoring system for ACoA aneurysms, enhancing the use of 3D CTA in daily practice and providing internal validation for the proposed approach. By evaluating objective criteria, this scoring system helps predict surgical risks, prevent complications, and supports personalized evaluation and selection of the surgical approach based on objective criteria.
本研究旨在通过使用 3D 成像方式对动脉瘤的方向以及手术入路的侧别和方法提供全面的术前信息，从而实现对手术侧别/方法的客观风险评估，并通过内部验证评估其效果。
回顾性分析了 2012 年至 2020 年间 61 例前交通动脉瘤患者的影像学资料。基于五个标准，制定了一种基于五项标准的评分系统：前交通动脉瘤瘤顶方向、A1 对称性/对照、穿通动脉控制、A2 痕迹方向和 A2 叉对称性。该系统旨在与前交通动脉瘤手术中最常见的手术方法保持一致。根据评分结果将患者分为三组，以确定最合适的手术方法。推荐组 I，推荐组 II 较少，推荐组 III 最少。进行内部验证以评估该系统的有效性。对结果和并发症发生率进行了统计学评估。
当使用评分系统时，第一组与其他两组之间的平均评分差异分别为 2.71 和 4.62。在年龄、性别、WFNS 和 Fisher 评分方面，各组之间的分布均匀。在组 I 中有 3 例患者发生并发症，在组 II 和组 III 中各有 9 例患者发生并发症。离第一个选择越远，并发症发生率越高（p=0.016），并且确定了显著的因果关系（p=0.021）。ROC 曲线为并发症和结果建立了 12.5 分的截断值。
我们的研究引入了一种新的前交通动脉瘤评分系统，增强了 3D CTA 在日常实践中的应用，并为所提出的方法提供了内部验证。通过评估客观标准，该评分系统有助于预测手术风险，预防并发症，并支持基于客观标准对手术方法进行个性化评估和选择。
