Microsurgical clipping and endovascular coiling for ruptured anterior circulation aneurysms
作者单位：Department of NeurosurgerySecond Affiliated Hospital Soochow University
会议名称：《第十四届中国医师协会神经外科医师年会》
会议日期：2019年
学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学]
关 键 词：neurosurgery intracranial aneurysm endovascular treatment surgical approach keyhole
摘 要：Purpose: Either microsurgical clipping or endovascular coiling can be selected for the treatment of ruptured intracranial aneurysms of anterior circulation in most cases. However, which one is better is still controversial. There are few prospective randomized controlled trials comparing the above two modalities currently, especially comparing with microsurgery via keyhole approaches, of which no report has been identified. We compared the therapeutic efficacy of microsurgical clipping via keyhole approaches with that via conventional approaches and endovascular coiling for ruptured intracranial aneurysms of anterior circulation. Methods: 150 patients harbored 170 aneurysms of anterior circulation amenable to both microsurgical clipping and endovascular coiling were randomized. 50 cases experienced microsurgical clipping via keyhole approaches（Keyhole Group） as well as 50 via conventional approaches（Conventional Group）. Other 50 cases were treated by endovascular coiling（Endovascular Group）. Results: All 170 aneurysms were managed in one stage. Neck clipping was achieved in 48 patients（58 aneurysms） via keyhole approaches as well as in 49 patients（55 aneurysms） via conventional approaches. Complete obliteration by endovascular coiling was achieved in 50 aneurysms. Based on Glasgow Outcome Scale, there were no statistical difference（P0.05） at discharge. There was no statistical difference in postoperative hospitalization between Endovascular Group and Keyhole Group（P0.05）, but both were shorter than that in Conventional Group（P0.01）. In terms of total hospitalization costs, Keyhole Group was less than Conventional Group（P0.01）, while Endovascular Group was significantly highest（P0.01）. Conclusions: Keyhole approaches are suitable for the treatment of ruptured intracranial aneurysms of anterior circulation that do not necessitate decomprassive craniectomy and are superior to conventional approaches. Compared with endovascular coiling, the therapeutic effect is eq