Systematic review and comparative analysis of endovascular and microsurgical management of giant ruptured fusiform mca aneurysms with illustrative cases.

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie Pub Date : 2024-10-01 DOI:10.1016/j.neuchi.2024.101601

Brandon Edelbach, Ha Yeon Lee, Miguel Angel Lopez-Gonzalez

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引用次数: 0

Abstract

Background: Despite advances in neurosurgical techniques and technology, the management of ruptured giant fusiform MCA aneurysms remains challenging. In the literature, microsurgical intervention is the most commonly described approach. However, recent advancements in endovascular techniques have expanded therapeutic options and as a result there is no consensus on the optimal management of these aneurysms.

Methods: A literature search was performed through the PubMed, Google Scholar, and Embase databases, for surgical and endovascular management of ruptured giant fusiform MCA aneurysms. Inclusion criteria included: fusiform morphology, hemorrhage, major diameter greater than 2.5 cm and located along the MCA.

Results: Literature review yielded 21 studies published from 1981 to 2023 and a total of 32 patients ages 33.40 ± 18.28. The male to female ratio was 1.9:1. The average Hunt and Hess score upon presentation in the total population was 2.78 ± 1.48, and the average pre-operative mRS of the total population was 2.75 ± 1.83. The average major diameter was 3.80 ± 1.85 cm. Average follow-up was 8.9 ± 9.74 months. There was no statistical difference in age (p = 0.5609), pre-operative mRS (p = 0.2355), Hunt and Hess scale (p = 0.183), aneurysm major diameter (p = 0.594) or follow-up (0.8922) between the two modalities. There was no significant difference in clinical outcome between microsurgical and endovascular intervention, nor was there a significant difference when stratified according to sex, major diameter, or location along the MCA. Two case examples are presented after management with cerebral revascularization.

Conclusion: Our analysis underscores the absence of statistical differences in clinical outcomes between microsurgical and endovascular strategies for ruptured giant fusiform MCA aneurysms, which highlights the need for complex surgical revascularization as represented on the illustrative cases where no endovascular option was available.

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对巨型纺锤形马氏动脉瘤破裂的血管内治疗和显微外科治疗进行系统回顾和比较分析，并附有病例说明。

背景：尽管神经外科技术和科技在不断进步，但处理破裂的巨大纺锤形 MCA 动脉瘤仍具有挑战性。在文献中，显微外科干预是最常见的方法。然而，血管内技术的最新进展扩大了治疗选择的范围，因此对于这些动脉瘤的最佳治疗方法还没有达成共识：方法：通过PubMed、Google Scholar和Embase数据库对破裂的巨大纺锤形MCA动脉瘤的手术和血管内治疗进行文献检索。纳入标准包括：纺锤形形态、出血、主要直径大于2.5厘米且位于MCA沿线：文献综述显示，有 21 项研究发表于 1981 年至 2023 年，共有 32 名患者，年龄为（33.40 ± 18.28）岁。男女比例为 1.9:1。所有患者发病时的 Hunt 和 Hess 评分平均为 2.78 ± 1.48，术前 mRS 平均为 2.75 ± 1.83。主要直径平均为 3.80 ± 1.85 厘米。平均随访时间为 8.9 ± 9.74 个月。两种方式在年龄（p = 0.5609）、术前 mRS（p = 0.2355）、Hunt 和 Hess 量表（p = 0.183）、动脉瘤大直径（p = 0.594）或随访（0.8922）方面均无统计学差异。显微外科手术和血管内介入治疗的临床结果没有明显差异，根据性别、大直径或沿 MCA 的位置进行分层后也没有明显差异。本文还介绍了两例脑血管再通治疗后的病例：我们的分析强调，对于破裂的巨型纺锤形 MCA 动脉瘤，显微外科手术和血管内介入治疗策略的临床结果没有统计学差异，这突出说明了在没有血管内介入治疗方案的示例病例中，需要进行复杂的外科血管再通手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurochirurgie 医学-临床神经学

CiteScore

2.70

自引率

6.20%

发文量

100

审稿时长

29 days

期刊介绍： Neurochirurgie publishes articles on treatment, teaching and research, neurosurgery training and the professional aspects of our discipline, and also the history and progress of neurosurgery. It focuses on pathologies of the head, spine and central and peripheral nervous systems and their vascularization. All aspects of the specialty are dealt with: trauma, tumor, degenerative disease, infection, vascular pathology, and radiosurgery, and pediatrics. Transversal studies are also welcome: neuroanatomy, neurophysiology, neurology, neuropediatrics, psychiatry, neuropsychology, physical medicine and neurologic rehabilitation, neuro-anesthesia, neurologic intensive care, neuroradiology, functional exploration, neuropathology, neuro-ophthalmology, otoneurology, maxillofacial surgery, neuro-endocrinology and spine surgery. Technical and methodological aspects are also taken onboard: diagnostic and therapeutic techniques, methods for assessing results, epidemiology, surgical, interventional and radiological techniques, simulations and pathophysiological hypotheses, and educational tools. The editorial board may refuse submissions that fail to meet the journal''s aims and scope; such studies will not be peer-reviewed, and the editor in chief will promptly inform the corresponding author, so as not to delay submission to a more suitable journal. With a view to attracting an international audience of both readers and writers, Neurochirurgie especially welcomes articles in English, and gives priority to original studies. Other kinds of article - reviews, case reports, technical notes and meta-analyses - are equally published. Every year, a special edition is dedicated to the topic selected by the French Society of Neurosurgery for its annual report.