Kanemaru Kazuya, Yoshioka Hideyuki, Hashimoto Koji, Senbokuya Nobuo, Arai Hajime, Fujimura Miki, Suzuki Kensuke, Matsuda Ko, Sakai Nobuyuki, Nishikawa Ryo, Murayama Yuichi, Takahashi Jun C, Inoue Tooru, Yoshimura Shinichi, Tominaga Teiji, Kinouchi Hiroyuki
Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan.
Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
World Neurosurg. 2025 Mar;195:123571. doi: 10.1016/j.wneu.2024.123571. Epub 2025 Jan 17.
Large or giant paraclinoid aneurysms have been treated with various strategies, including clipping, coiling, and parent artery occlusion (PAO). In addition, flow diverters (FDs) have been introduced for the management of these aneurysms. The aim of this study was to examine the management of unruptured large/giant paraclinoid aneurysms in Japan when FDs were being introduced by a nationwide survey.
A total of 576 unruptured large/giant paraclinoid aneurysms treated in Japan between January 2012 and December 2016 were retrospectively studied.
Half of the large paraclinoid aneurysms were treated by coiling (50.3%), whereas giant aneurysms were occluded mainly by PAO (51.4%). A high nearly complete occlusion rate was achieved with clipping (94.1%), coiling (85.9%), PAO (82.4%), and FDs (77.6%). Coiling had higher risks of recurrence (28.3%) and retreatment (20.3%). Major procedure-related complications were observed in 9.7%. Ischemic complications were common in PAO (9.5%), with cranial nerve symptoms common in clipping (10.9%). All treatment modalities achieved good clinical outcomes (93.5%-96.6%). Although not significant, pre-existing visual disturbance improved most frequently by clipping (53.7%), but also worsened most frequently by clipping (24.4%). Consequently, FD achieved a high occlusion rate with minimal complication and retreatment rates.
All treatment modalities offer high rates of complete occlusion and good clinical outcomes. Coiling has the disadvantage of high rates of recurrence and retreatment. Clipping and PAO have the disadvantage of a high rate of major procedure-related complications; however, PAO can provide comparable treatment outcomes even in cases with refractory giant aneurysms. FDs are the optimal choice for the management for large/giant paraclinoid aneurysms due to its safety and efficacy.
大型或巨大型床突旁动脉瘤已采用多种策略进行治疗，包括夹闭、栓塞和载瘤动脉闭塞术（PAO）。此外，血流导向装置（FD）已被用于这些动脉瘤的治疗。本研究旨在通过一项全国性调查，探讨在日本引入FD时未破裂大型/巨大型床突旁动脉瘤的治疗情况。
回顾性研究2012年1月至2016年12月期间在日本治疗的576例未破裂大型/巨大型床突旁动脉瘤。
大型床突旁动脉瘤半数采用栓塞治疗（50.3%），而巨大动脉瘤主要采用PAO闭塞（51.4%）。夹闭（94.1%）、栓塞（85.9%）、PAO（82.4%）和FD（77.6%）均实现了较高的近乎完全闭塞率。栓塞的复发风险（28.3%）和再次治疗风险（20.3%）较高。观察到9.7%的患者出现主要的手术相关并发症。缺血性并发症在PAO中常见（9.5%），夹闭时常见颅神经症状（10.9%）。所有治疗方式均取得了良好的临床效果（93.5%-96.6%）。虽然差异无统计学意义，但术前存在的视力障碍最常通过夹闭得到改善（53.7%），但也最常因夹闭而恶化（24.4%）。因此，FD实现了高闭塞率，并发症和再次治疗率最低。
所有治疗方式均能实现高完全闭塞率和良好的临床效果。栓塞的缺点是复发率和再次治疗率高。夹闭和PAO的缺点是手术相关主要并发症发生率高；然而，即使在难治性巨大动脉瘤病例中，PAO也能提供相当的治疗效果。由于其安全性和有效性，FD是大型/巨大型床突旁动脉瘤治疗的最佳选择。
