Acha Sánchez José Luis, Bocanegra-Becerra Jhon E, Contreras Montenegro Luis, Bellido Adriana, Contreras Shamir, Santos Oscar
Department of Neurosurgery, Hospital Nacional Dos de Mayo, Lima, Peru.
Academic Department of Surgery, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
World Neurosurg. 2025 Mar;195:123694. doi: 10.1016/j.wneu.2025.123694. Epub 2025 Feb 17.
Microsurgery for paraclinoid aneurysms remains the first line of treatment in resource-constrained settings. The authors describe their institutional experience and evaluate functional outcomes after microsurgical treatment of paraclinoid aneurysms.
A retrospective review of clinical records was conducted. Multivariable logistic regression assessed predictors of good functional outcomes (modified Rankin Scale score ≤ 2) at last follow-up.
Fifty-six patients (80.4% female; mean age: 55.55 ± 11.27 years) with 58 paraclinoid aneurysms were analyzed. Most paraclinoid aneurysms were located in the ophthalmic segment (53.5%), presented in a ruptured state (56.9%), measured 10-25 mm (65.5%), and had a wide neck (median: 5.2 mm [interquartile range: 4.3-5.78]). The median time from symptom onset to intervention was five days (interquartile range: 3-10). About 51.8% of patients presented with visual deficits. Aneurysm repair involved clipping (87.5%) and clipping with bypass surgery (12.5%). Most cases were performed under a minipterional craniotomy (51.8%) with extradural anterior clinoidectomy (71.4%), carotid control (92.9%), fluorescence angiography (91.1%), and intraoperative Doppler (89.3%). The intraoperative aneurysm rupture rate was 7.1%. An increasing Hunt and Hess score at presentation was associated with lower odds of good functional outcomes (odds ratio: 0.25, 95% confidence interval 0.03-0.745; P = 0.038). At the 6-month follow-up, 91.1% of patients had good outcomes and 72.4% had improved visual outcomes.
The present series showcases the valuable role of microsurgical treatment for patients with paraclinoid aneurysms. Despite the challenges posed by the poor grade of subarachnoid hemorrhage and delayed intervention, microsurgical techniques remain essential to optimizing functional outcomes and minimizing surgical morbidity.
在资源有限的情况下，显微手术治疗床突旁动脉瘤仍是一线治疗方法。作者描述了他们所在机构的经验，并评估了显微手术治疗床突旁动脉瘤后的功能结局。
对临床记录进行回顾性分析。多变量逻辑回归分析评估了末次随访时良好功能结局（改良Rankin量表评分≤2）的预测因素。
分析了56例患者（女性占80.4%；平均年龄：55.55±11.27岁）的58个床突旁动脉瘤。大多数床突旁动脉瘤位于眼动脉段（53.5%），呈破裂状态（56.9%），大小为10 - 25mm（65.5%），且瘤颈较宽（中位数：5.2mm[四分位间距：4.3 - 5.78]）。从症状出现到干预的中位时间为5天（四分位间距：3 - 10天）。约51.8%的患者出现视力障碍。动脉瘤修复包括夹闭术（87.5%）和夹闭术联合搭桥手术（12.5%）。大多数病例采用额颞小骨窗开颅术（51.8%），并进行硬膜外前床突切除术（71.4%）、颈动脉控制（92.9%）、荧光血管造影（91.1%）和术中多普勒检查（89.3%）。术中动脉瘤破裂率为7.1%。就诊时Hunt和Hess评分增加与良好功能结局的几率降低相关（比值比：0.25，95%置信区间0.03 - 0.745；P = 0.038）。在6个月的随访中，91.1%的患者预后良好，72.4%的患者视力改善。
本系列研究展示了显微手术治疗床突旁动脉瘤患者的重要作用。尽管蛛网膜下腔出血分级差和干预延迟带来了挑战，但显微手术技术对于优化功能结局和降低手术并发症仍然至关重要。
