Treatment of Unruptured Large and Giant Paraclinoid Aneurysms in Japan at the Time of Flow Diverter Introduction: A Nationwide, Multicenter Survey by the Japanese Society on Surgery for Cerebral Stroke.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2024-12-14 DOI:10.1016/j.wneu.2024.123571

Kazuya Kanemaru, Hideyuki Yoshioka, Koji Hashimoto, Nobuo Senbokuya, Hajime Arai, Miki Fujimura, Kensuke Suzuki, Ko Matsuda, Nobuyuki Saka, Ryo Nishikawa, Yuichi Murayama, Jun C Takahashi, Tooru Inoue, Shinichi Yoshimura, Teiji Tominaga, Hiroyuki Kinouchi

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引用次数: 0

Abstract

Background and objectives: Large or giant paraclinoid aneurysms have been treated with various strategies, including clipping, coiling, and parent artery occlusion (PAO). In addition, flow diverters (FDs) have been introduced for the management of these aneurysms. The aim of this study was to examine the management of unruptured large/giant paraclinoid aneurysms in Japan when FDs were being introduced by a nationwide survey.

Methods: A total of 576 unruptured large/giant paraclinoid aneurysms treated in Japan between January 2012 and December 2016 were retrospectively studied.

Results: Half of the large paraclinoid aneurysms were treated by coiling (50.3%), whereas giant aneurysms were occluded mainly by PAO (51.4%). A high nearly complete occlusion rate was achieved with clipping (94.1%), coiling (85.9%), PAO (82.4%), and FDs (77.6%). Coiling had higher risks of recurrence (28.3%) and retreatment (20.3%). Major procedure-related complications were observed in 9.7%. Ischemic complications were common in PAO (9.5%), with cranial nerve symptoms common in clipping (10.9%). All treatment modalities achieved good clinical outcomes (93.5-96.6%). Although not significant, pre-existing visual disturbance improved most frequently by clipping (53.7%), but also worsened most frequently by clipping (24.4%). Consequently, FD achieved a high occlusion rate with minimal complication and retreatment rates.

Conclusion: All treatment modalities offer high rates of complete occlusion and good clinical outcomes. Coiling has the disadvantage of high rates of recurrence and retreatment. Clipping and PAO have the disadvantage of a high rate of major procedure-related complications; however, PAO can provide comparable treatment outcomes even in cases with refractory giant aneurysms. FDs are the optimal choice for the management for large/giant paraclinoid aneurysms due to its safety and efficacy.

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背景和目的：大型或巨型椎旁动脉瘤的治疗方法多种多样，包括剪切、卷绕和母动脉闭塞（PAO）。此外，还引入了血流分流器（FD）来治疗这些动脉瘤。本研究的目的是通过一项全国性调查，研究日本在引入血流分流器时对未破裂的大型/巨型旁动脉瘤的处理情况：方法：对2012年1月至2016年12月期间在日本治疗的576例未破裂的大/巨伞状动脉瘤进行回顾性研究：结果：半数的大型椎旁动脉瘤通过卷绕治疗（50.3%），而巨大动脉瘤主要通过PAO闭塞（51.4%）。夹闭术（94.1%）、卷紮术（85.9%）、PAO（82.4%）和FDs（77.6%）都能达到较高的近乎完全闭塞率。卷曲术的复发风险（28.3%）和再治疗风险（20.3%）较高。与手术相关的主要并发症占 9.7%。缺血性并发症常见于 PAO（9.5%），颅神经症状常见于剪切术（10.9%）。所有治疗方法都取得了良好的临床效果（93.5%-96.6%）。尽管并不显著，但已有的视力障碍最常因剪切而改善（53.7%），但也最常因剪切而恶化（24.4%）。因此，FD 的闭塞率高，并发症和再治疗率低：结论：所有治疗方法都具有较高的完全闭塞率和良好的临床效果。结论：所有治疗方法都具有较高的完全闭塞率和良好的临床疗效。夹闭和 PAO 的缺点是与手术相关的主要并发症发生率高；不过，即使是难治性巨大动脉瘤，PAO 也能提供相当的治疗效果。由于其安全性和有效性，FDs 是治疗大型/巨型旁动脉瘤的最佳选择。

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS