Inci Servet, Kalaycioglu Sacide
Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
Neurosurg Rev. 2025 Jun 12;48(1):504. doi: 10.1007/s10143-025-03634-7.
This study includes the surgical treatment of 31 patients with bilateral MCA (bMCA) aneurysms using a unilateral approach and is the second largest series in the literature. The main aim of this study is to present a proposed grading system to preoperatively predict the difficulties in this approach. The clinical files, radiological studies, operation records, intraoperative video recordings, complications and outcomes of 31 patients were retrospectively reviewed. In the first part of this study (2001-2010), we operated on 22 patients with bMCA aneurysms and were able to clip the contralateral aneurysm via unilateral approach in only 12 cases (54.5%). Considering our experience from the surgery of these patients, we identified 5 parameters that reveal surgical difficulties. In the second part of the study (2011-2023), considering these 5 parameters, 20 patients were selected for unilateral approach and bilateral aneurysms could be clipped in 19 patients (95%). As a result, 26 of 31 patients (83.9%) were discharged with a favorable outcome (mRS 0-2, excellent-good). Intraoperative rupture occurred in one patient. Based on our experience, we developed a grading system with a total of 10 points by assigning points according to the degree of difficulty of each parameter and classified surgical difficulty as follows: 0-1 low difficulty, 2-3 moderate difficulty, 4-6 high difficulty and 7-10 very high difficulty. Patients with bMCA aneurysms can be operated via unilateral approach in experienced hands in properly selected cases. This grading system may help the neurosurgeon in this selection by preoperatively predicting intraoperative difficulties. This study is a completely retrospective file scan. This is not a clinical trial. Clinical trial number: not applicable.
本研究纳入了31例采用单侧入路治疗双侧大脑中动脉（bMCA）动脉瘤的患者，是文献报道中第二大样本量的系列研究。本研究的主要目的是提出一种分级系统，用于术前预测该入路的手术难度。我们回顾性分析了31例患者的临床资料、影像学检查、手术记录、术中视频录像、并发症及预后情况。在本研究的第一部分（2001 - 2010年），我们对22例bMCA动脉瘤患者进行了手术，仅12例（54.5%）能够通过单侧入路夹闭对侧动脉瘤。根据这些患者的手术经验，我们确定了5个揭示手术难度的参数。在研究的第二部分（2011 - 2023年），考虑到这5个参数，选择了20例患者采用单侧入路，其中19例（95%）成功夹闭了双侧动脉瘤。结果，31例患者中有26例（83.9%）出院时预后良好（改良Rankin量表评分0 - 2分，优 - 良）。1例患者术中发生破裂。基于我们的经验，我们通过根据每个参数的困难程度分配分数，开发了一个总分10分的分级系统，并将手术难度分类如下：0 - 1分为低难度，2 - 3分为中度难度，4 - 6分为高难度，7 - 10分为极高难度。在经验丰富的医生手中，对于经过适当选择的病例，bMCA动脉瘤患者可以通过单侧入路进行手术。该分级系统可以通过术前预测术中困难，帮助神经外科医生进行病例选择。本研究是完全回顾性的病历扫描。这不是一项临床试验。临床试验编号：不适用。
