Eide Per Kristian, Sorteberg Wilhelm, Pripp Are H, Rønning Pål A, Sorteberg Angelika G
Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Acta Neurochir (Wien). 2025 Sep 13;167(1):244. doi: 10.1007/s00701-025-06670-w.
To compare surgical and endovascular therapy (EVT) approaches to aneurysm repair in all aneurysmal subarachnoid hemorrhage (aSAH) patients treated within our institution over a 12-year period from 2011 to 2022.
The study comprised a retrospective analysis of prospectively collected data extracted from a hospital quality registry that we established in 2011, containing comprehensive information about all patients treated for aSAH. We included SAH patients within the institution's catchment area who underwent surgical or endovascular aneurysm repair. Exclusion criteria involved patients from external regions, those treated at other institutions, no aneurysm repair performed, or instances undergoing a combination of surgery and EVT. Pretreatment data encompassed the clinical condition at admission, comorbidity, radiological details, aneurysm characteristics, and duration between the bleed and aneurysm repair. Mortality was primary outcome measure; secondary outcome included modified Rankin Score after approximately six months.
The study encompassed 1,171 patients (65% women and 35% men) undergoing aneurysm repair from 2011 to 2022. Admission data revealed 31.1% in Hunt-Hess grade 4-5. Surgical repair was performed in 573 (48.9%) patients, and EVT in 598 (51.1%) patients. Pretreatment information was comparable for both groups. Kaplan-Meier survival curves demonstrated lower mortality in the surgical than the EVT group (P = 0.023; Log-rank test) over the 12-year period. The 1-year, 5-year, and 10-year mortality rates were 12.4%, 19.5%, and 27.7% for the surgery group, and 18.7%, 25.2%, and 31.7% for the EVT group, respectively. Modified Rankin Score was worse for EVT. There was lower mortality in surgical than EVT groups in patients treated for anterior communicating artery (ACOM, n = 420) and posterior communicating artery (PCOM, n = 177) aneurysms. Shorter time to aneurysm repair and more extensive cerebrospinal fluid (CSF) drainage characterized the surgery group.
Mortality was lower in surgical patients. Plausible explanations are the maintenance of surgical skills and prompt reduction of intracranial pressure.
比较2011年至2022年期间在本机构接受治疗的所有动脉瘤性蛛网膜下腔出血（aSAH）患者的动脉瘤修复手术和血管内治疗（EVT）方法。
该研究包括对从我们于2011年建立的医院质量登记处提取的前瞻性收集数据进行回顾性分析，其中包含所有接受aSAH治疗患者的综合信息。我们纳入了在该机构服务区域内接受手术或血管内动脉瘤修复的SAH患者。排除标准包括来自外部地区的患者、在其他机构接受治疗的患者、未进行动脉瘤修复的患者或接受手术和EVT联合治疗的病例。预处理数据包括入院时的临床状况、合并症、放射学细节、动脉瘤特征以及出血与动脉瘤修复之间的时间间隔。死亡率是主要结局指标；次要结局包括大约六个月后的改良Rankin评分。
该研究涵盖了2011年至2022年期间接受动脉瘤修复的1171名患者（65%为女性，35%为男性）。入院数据显示，Hunt-Hess分级为4-5级的患者占31.1%。573名（48.9%）患者接受了手术修复，598名（51.1%）患者接受了EVT。两组的预处理信息具有可比性。Kaplan-Meier生存曲线显示，在12年期间，手术组的死亡率低于EVT组（P = 0.023；对数秩检验）。手术组的1年、5年和10年死亡率分别为12.4%、19.5%和27.7%，EVT组分别为18.7%、25.2%和31.7%。EVT组的改良Rankin评分更差。在接受前交通动脉（ACOM，n = 420）和后交通动脉（PCOM，n = 177）动脉瘤治疗的患者中，手术组的死亡率低于EVT组。手术组的动脉瘤修复时间更短，脑脊液（CSF）引流更广泛。
手术患者的死亡率较低。合理的解释是手术技能的保持和颅内压的迅速降低。
