Efficacy And Safety Of Microsurgical Clipping And Intravascular Interventional Embolization In The Treatment Of Middle Cerebral Artery Aneurysm

Objective: To compare the safety and viability of microsurgical clipping and endovascular embolization in the treatment of grade I,II and III middle cerebral artery aneurysms bifurcation after rupture.Methods: Enrolled 80 patients with low-grade middle cerebral artery aneurysm ruptured bifurcation who were treated in our hospital from January 2012 to October 2016 were retrospectively analyzed and divided into two groups,60 patients into operation group(microsurgical clipping)and 20 patients into Intervention group(endovascular embolization).First,we compared the difference between general information and aneurysm information of patients.Then we compared the adverse events,prognosis,hospitalization days and hospitalization costs of the two treatment methods.Determine the surgical group,intervention group and prognostic score(GOS score)whether there is correlation.Further comparison of wide-necked aneurysm tissue adverse events,the clinical prognosis is there any difference.Results:(1)During the hospital,adverse events occurred in 2 patients(10.0%)in the intervention group,and 20 patients(33.3%)in the operation group had adverse events.There were significant differences between the two groups.During the hospital,intracranial infection,cerebral vasospasm,cerebral ischemia,postoperative hemorrhage,sick back,convulsions showed no significant difference between the two groups.(2)After 6 months of follow-up,the prognosis of the intervention group was good in 18cases(90%)and 55 cases(91.7%)in the operation group,and there was no significant difference between the two groups.(3)Average length of stay is(10 ± 5)days in Intervention group and(17 ± 9)days in operation group,shows significant difference between the two groups.(4)The cost of the intervention group is(128022 ± 33682)yuan,and the operation group is(78441 ± 37110)yuan,with significant difference between the two groups.(5)There was no correlation between two groups of preoperative aneurysm classification(hutt-hess)and prognostic score(GOS).(6)Wide-necked aneurysms: The intervention group had a good prognosis of 13 cases(86.7%),which was lower than the surgical group of 43 cases(91.5%),with no significant difference.One case(6.7%)of adverse events in intervention group was lower than 18 cases(38.3%)in operation group,with significant statistical difference.Conclusion: On the bifurcation of low-grade aneurysms,both endovascular embolization and microsurgical clipping have good prognosis.Conpared with surgical clipping,endovascular treatment have high safty and short hospital stay,but the cost is higher.The clinical decision-making should be based on the patients’ economic conditions and the characteristics of aneurysms,and then we can choose a more approriate treatment.