Xu Qingqing, Tian Qi, Han Wenrui, Liu Chengli, Liao Jianming, Li Mingchang
Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China.
Quant Imaging Med Surg. 2025 Jun 6;15(6):5604-5620. doi: 10.21037/qims-2024-2848. Epub 2025 May 20.
Generally, extremely small intracranial aneurysms (ESIAs) are defined as having a maximum diameter of less than 2 mm. Despite technological improvement, treating ESIAs remains challenging for neurosurgery specialists. ESIA treatment has long been controversial owing to the high risk of complications associated with both endovascular coiling (EC) and microsurgical clipping (MC). This retrospective cohort study assessed postoperative complications, angiographic outcomes, and long-term clinical efficacy in ESIAs patients receiving EC or MC interventions. The objective was to evaluate the effectiveness of different surgical interventions for patients diagnosed with ESIAs.
Patients who underwent EC or MC between February 2013 and December 2023 were retrospectively analyzed. A total of 153 patients were included in this study, encompassing both ruptured and unruptured cases of ESIAs. Notably, unruptured cases were associated with larger ipsilateral aneurysms, which were either ruptured or at a significant risk of rupture. Imaging follow-up evaluations were conducted using computed tomography angiography (CTA) or digital subtraction angiography (DSA), whereas patient recovery outcomes were assessed using the Glasgow Outcome Scale (GOS). The primary outcome measure was the GOS score recorded 6 months post-treatment. Secondary outcomes included the GOS score at discharge, the embolization rate 6 months after treatment, and postoperative complications such as cerebral infarction, hydrocephalus, and postoperative rebleeding.
This study included 153 patients, 84 of whom were treated with EC and 69 with MC. In the EC group, 28 cases of unruptured aneurysms were identified, whereas the MC group had 20 cases of unruptured aneurysms. EC treatment demonstrated slight benefits in clinical outcomes at discharge, with statistically significant differences 6 months after treatment. The EC group had a shorter hospital stay compared with the MC group (14.40±6.57 20.17±7.38 days, P<0.0001), but there was no significant difference in special complications (16.67% 27.54%, P=0.1038). Postoperative angiography revealed a lower occlusion rate in the EC group at discharge (84.52% 100%) and 6 months after treatment (88.10% 89.86%). Subgroup analysis for a favorable outcome revealed a sex-related difference between the EC and MC groups at follow-up. Specifically, female patients treated with EC demonstrated a better long-term prognosis compared with those treated with MC.
Both EC and MC treatments are suitable for patients with ESIAs. However, the EC group exhibited fewer hospitalization days than the MC group, whereas the latter demonstrated a higher occlusion rate. Female patients may have better long-term outcomes with EC treatment. Further confirmation through large-sample, multi-center trials is needed.
一般来说，极小颅内动脉瘤（ESIAs）被定义为最大直径小于2毫米。尽管技术有所进步，但对神经外科专家而言，治疗ESIAs仍然具有挑战性。由于血管内栓塞（EC）和显微手术夹闭（MC）都存在较高的并发症风险，ESIAs的治疗长期以来一直存在争议。这项回顾性队列研究评估了接受EC或MC干预的ESIAs患者的术后并发症、血管造影结果和长期临床疗效。目的是评估不同手术干预对诊断为ESIAs患者的有效性。
回顾性分析2013年2月至2023年12月期间接受EC或MC治疗的患者。本研究共纳入153例患者，包括破裂和未破裂的ESIAs病例。值得注意的是，未破裂病例与同侧较大的动脉瘤相关，这些动脉瘤要么已经破裂，要么有显著的破裂风险。使用计算机断层扫描血管造影（CTA）或数字减影血管造影（DSA）进行影像学随访评估，而使用格拉斯哥预后量表（GOS）评估患者的恢复结果。主要结局指标是治疗后6个月记录的GOS评分。次要结局包括出院时的GOS评分、治疗后6个月的栓塞率以及术后并发症，如脑梗死、脑积水和术后再出血。
本研究包括153例患者，其中84例接受EC治疗，69例接受MC治疗。在EC组中，发现28例未破裂动脉瘤，而MC组有20例未破裂动脉瘤。EC治疗在出院时的临床结局方面显示出轻微优势，治疗后6个月有统计学显著差异。与MC组相比，EC组的住院时间更短（14.40±6.57对20.17±7.38天，P<0.0001），但特殊并发症方面无显著差异（16.67%对27.54%，P=0.1038）。术后血管造影显示，EC组出院时（84.52%对100%）和治疗后6个月（88.10%对89.86%）的闭塞率较低。对良好结局的亚组分析显示，随访时EC组和MC组之间存在性别差异。具体而言，接受EC治疗的女性患者与接受MC治疗的女性患者相比，长期预后更好。
EC和MC治疗都适用于ESIAs患者。然而，EC组的住院天数比MC组少，而后者的闭塞率更高。女性患者接受EC治疗可能有更好的长期结局。需要通过大样本、多中心试验进一步证实。
