Filipi Fim Andreão, Helvécio Neves Feitosa Filho, Emanuel Abrantes Barros, José Gabriel Abreu Moreira, Matheus Hemais, Ary Rodrigues Neto, Luiz Guilherme Silva Almeida, Niels Pacheco-Barrios, Thayne Alexsandra Carneiro, Vitor Salviato Nespoli, Fausto Braga, Cesar Augusto Alves Ferreira Filho, Elias Tanus, José Alberto Almeida Filho
{"title":"血管内手术还是显微手术?确定治疗血泡动脉瘤的最佳方法:一项比较荟萃分析。","authors":"Filipi Fim Andreão, Helvécio Neves Feitosa Filho, Emanuel Abrantes Barros, José Gabriel Abreu Moreira, Matheus Hemais, Ary Rodrigues Neto, Luiz Guilherme Silva Almeida, Niels Pacheco-Barrios, Thayne Alexsandra Carneiro, Vitor Salviato Nespoli, Fausto Braga, Cesar Augusto Alves Ferreira Filho, Elias Tanus, José Alberto Almeida Filho","doi":"10.1177/19714009251346467","DOIUrl":null,"url":null,"abstract":"<p><p>IntroductionBlood blister-like aneurysms (BBLAs) are rare, typically found in the anteromedial supraclinoid segment of the internal carotid artery, and are related to high morbidity and mortality rates. Although microsurgery has been traditionally used to manage BBLAs, the Endovascular treatment (EVT) is gaining importance. We aim to compare these two methods using a systematic review and meta-analysis.MethodsA systematic search of PubMed, Embase, and Web of Science databases following PRISMA guidelines was conducted. We pooled odds ratios (OR) with 95% confidence intervals using a random-effects model, and I<sup>2</sup> to assess heterogeneity. Eligible studies compared microsurgery and EVT for BBLAs. Outcome measures included Good and Poor clinical outcomes by Modified Rankin Scale (mRS), Epilepsy, Infection, Intracranial Hemorrhage, Vasospasm, Ischemic Events, Mortality, Operative Rupture, Rebleeding, Recurrence, and Retreatment.ResultsFifteen studies with 770 patients were included (401 microsurgery; 369 EVT). EVT appeared to be protective against Poor Clinical Outcomes (mRS >2), with an OR of 0.43 (95% CI 0.21 to 0.87), and Ischemic Events, having an OR of 0.33 (95% CI 0.18 to 0.61). Microsurgery was related to higher Mortality, with an OR of 2.72 (95% CI 1.46 to 5.06), and Operative Rupture, with 7.72 (95% CI 3.50 to 17.07). EVT also statistically favored the Good Clinical Outcomes analysis, with an OR of 3.13 (95% CI 1.40 to 6.98). Epilepsy, Infection, Intracranial Hemorrhage, and Vasospasm occurrence showed no significant statistical difference.ConclusionDespite microsurgery being traditionally used in BBLAs management, EVT has been shown to be a safer and lower-morbidity option.</p>","PeriodicalId":47358,"journal":{"name":"Neuroradiology Journal","volume":" ","pages":"19714009251346467"},"PeriodicalIF":0.8000,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165959/pdf/","citationCount":"0","resultStr":"{\"title\":\"Endovascular or microsurgical? 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We aim to compare these two methods using a systematic review and meta-analysis.MethodsA systematic search of PubMed, Embase, and Web of Science databases following PRISMA guidelines was conducted. We pooled odds ratios (OR) with 95% confidence intervals using a random-effects model, and I<sup>2</sup> to assess heterogeneity. Eligible studies compared microsurgery and EVT for BBLAs. Outcome measures included Good and Poor clinical outcomes by Modified Rankin Scale (mRS), Epilepsy, Infection, Intracranial Hemorrhage, Vasospasm, Ischemic Events, Mortality, Operative Rupture, Rebleeding, Recurrence, and Retreatment.ResultsFifteen studies with 770 patients were included (401 microsurgery; 369 EVT). EVT appeared to be protective against Poor Clinical Outcomes (mRS >2), with an OR of 0.43 (95% CI 0.21 to 0.87), and Ischemic Events, having an OR of 0.33 (95% CI 0.18 to 0.61). Microsurgery was related to higher Mortality, with an OR of 2.72 (95% CI 1.46 to 5.06), and Operative Rupture, with 7.72 (95% CI 3.50 to 17.07). EVT also statistically favored the Good Clinical Outcomes analysis, with an OR of 3.13 (95% CI 1.40 to 6.98). Epilepsy, Infection, Intracranial Hemorrhage, and Vasospasm occurrence showed no significant statistical difference.ConclusionDespite microsurgery being traditionally used in BBLAs management, EVT has been shown to be a safer and lower-morbidity option.</p>\",\"PeriodicalId\":47358,\"journal\":{\"name\":\"Neuroradiology Journal\",\"volume\":\" \",\"pages\":\"19714009251346467\"},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2025-06-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165959/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neuroradiology Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/19714009251346467\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"NEUROIMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuroradiology Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/19714009251346467","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"NEUROIMAGING","Score":null,"Total":0}
引用次数: 0
摘要
血液水疱样动脉瘤(BBLAs)是一种罕见的动脉瘤,通常发生在颈内动脉前内侧上突段,发病率和死亡率高。虽然显微手术传统上用于治疗脑卒中,但血管内治疗(EVT)正变得越来越重要。我们的目的是通过系统回顾和荟萃分析来比较这两种方法。方法按照PRISMA指南系统检索PubMed、Embase和Web of Science数据库。我们使用随机效应模型合并优势比(OR)和95%置信区间,并使用I2来评估异质性。符合条件的研究比较了显微手术和EVT治疗bbla。预后指标包括通过改良兰金量表(mRS)、癫痫、感染、颅内出血、血管痉挛、缺血性事件、死亡率、手术破裂、再出血、复发和再治疗的临床预后好坏。结果纳入15项研究770例患者(401例显微外科;369 EVT)。EVT似乎对不良临床结果(mRS bbbb2)具有保护作用,OR为0.43 (95% CI 0.21至0.87),OR为0.33 (95% CI 0.18至0.61)。显微手术与较高的死亡率相关,OR为2.72 (95% CI 1.46 ~ 5.06),手术破裂相关,OR为7.72 (95% CI 3.50 ~ 17.07)。EVT在统计学上也有利于良好临床结果分析,OR为3.13 (95% CI 1.40至6.98)。癫痫、感染、颅内出血、血管痉挛发生率无统计学差异。结论尽管显微手术传统上用于治疗乙型脑卒中,但EVT已被证明是一种更安全、发病率更低的选择。
Endovascular or microsurgical? Defining the best approach for blood blister aneurysms: A comparative meta-analysis.
IntroductionBlood blister-like aneurysms (BBLAs) are rare, typically found in the anteromedial supraclinoid segment of the internal carotid artery, and are related to high morbidity and mortality rates. Although microsurgery has been traditionally used to manage BBLAs, the Endovascular treatment (EVT) is gaining importance. We aim to compare these two methods using a systematic review and meta-analysis.MethodsA systematic search of PubMed, Embase, and Web of Science databases following PRISMA guidelines was conducted. We pooled odds ratios (OR) with 95% confidence intervals using a random-effects model, and I2 to assess heterogeneity. Eligible studies compared microsurgery and EVT for BBLAs. Outcome measures included Good and Poor clinical outcomes by Modified Rankin Scale (mRS), Epilepsy, Infection, Intracranial Hemorrhage, Vasospasm, Ischemic Events, Mortality, Operative Rupture, Rebleeding, Recurrence, and Retreatment.ResultsFifteen studies with 770 patients were included (401 microsurgery; 369 EVT). EVT appeared to be protective against Poor Clinical Outcomes (mRS >2), with an OR of 0.43 (95% CI 0.21 to 0.87), and Ischemic Events, having an OR of 0.33 (95% CI 0.18 to 0.61). Microsurgery was related to higher Mortality, with an OR of 2.72 (95% CI 1.46 to 5.06), and Operative Rupture, with 7.72 (95% CI 3.50 to 17.07). EVT also statistically favored the Good Clinical Outcomes analysis, with an OR of 3.13 (95% CI 1.40 to 6.98). Epilepsy, Infection, Intracranial Hemorrhage, and Vasospasm occurrence showed no significant statistical difference.ConclusionDespite microsurgery being traditionally used in BBLAs management, EVT has been shown to be a safer and lower-morbidity option.
期刊介绍:
NRJ - The Neuroradiology Journal (formerly Rivista di Neuroradiologia) is the official journal of the Italian Association of Neuroradiology and of the several Scientific Societies from all over the world. Founded in 1988 as Rivista di Neuroradiologia, of June 2006 evolved in NRJ - The Neuroradiology Journal. It is published bimonthly.