Padmanaban Varun, Harbaugh Thaddeus, Zhu Junjia, Zhou Shouhao, Ansari Sameer A, Howington Jay U, Sahlein Daniel H, Tejada Juan G, Wilkinson D Andrew, Simon Scott D, Cockroft Kevin M, Church Ephraim W
Department of Neurosurgery, Penn State Health, Hershey , Pennsylvania , USA.
Department of Public Health Sciences, Penn State Health, Hershey , Pennsylvania , USA.
Neurosurgery. 2024 Nov 21;97(1):112-119. doi: 10.1227/neu.0000000000003283.
Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms.
The NeuroVascular Quality Initiative-Quality Outcomes Database registry was queried for patients with tiny unruptured MCA aneurysms who underwent treatment. Tiny size was defined as an aneurysm with a maximum dimension of ≤3 mm. Demographics, aneurysm characteristics, and treatment safety were queried. Outcomes included modified Rankin Score (mRS) at discharge and the last follow-up as well as aneurysm occlusion status at discharge.
Of 674 treated, unruptured MCA aneurysms, 57 (8.5%) were tiny. The mean aneurysm width was 2.2 mm, and the mean patient age was 55.9 years. Most aneurysms were treated with microsurgery (61.4%, 35/57). The overall intraoperative complication rate was 5.3% (3/57), and the postoperative complication rate was 10.5% (6/57). 10.5% (6/57) of patients were discharged to rehabilitation. At discharge, 42 (87.5%) of the treated aneurysms had complete occlusion. In the subgroup of patients with recorded follow-up data, 48.3% (14/29) had a mRS of 0 at discharge and 46.9% (15/32) had an mRS of 0 at the last follow-up (median follow-up 166 days).
Treatment of tiny, unruptured MCA aneurysms is efficacious but may have a high rate of complications. Physicians should be cautious when deciding to treat tiny, unruptured MCA aneurysms.
改进后的成像方式使得颅内动脉瘤的检出率增加，其中许多是小型动脉瘤。对于微小动脉瘤的恰当治疗存在不确定性。本研究的目的是使用一个大型的多机构神经血管质量改进计划-质量结果数据库（NVQI-QOD）来评估微小、未破裂大脑中动脉（MCA）动脉瘤的治疗频率、安全性和疗效。
在神经血管质量改进计划-质量结果数据库登记处查询接受治疗的微小未破裂MCA动脉瘤患者。微小尺寸定义为最大直径≤3mm的动脉瘤。查询人口统计学、动脉瘤特征和治疗安全性。结果包括出院时和最后一次随访时的改良Rankin量表评分（mRS）以及出院时的动脉瘤闭塞状态。
在674例接受治疗的未破裂MCA动脉瘤中，57例（8.5%）为微小动脉瘤。动脉瘤平均宽度为2.2mm，患者平均年龄为55.9岁。大多数动脉瘤采用显微手术治疗（61.4%，35/57）。总体术中并发症发生率为5.3%（3/57），术后并发症发生率为10.5%（6/57）。10.5%（6/57）的患者出院后接受康复治疗。出院时，42例（87.5%）接受治疗的动脉瘤实现完全闭塞。在有记录的随访数据亚组中，48.3%（14/29）的患者出院时mRS为0，46.9%（15/32）的患者在最后一次随访时mRS为0（中位随访时间166天）。
微小、未破裂MCA动脉瘤的治疗是有效的，但可能有较高的并发症发生率。医生在决定治疗微小、未破裂MCA动脉瘤时应谨慎。
