| Background Intracranial aneurysm is an abnormal bulging of intracranial arterial wall, is the main cause of subarachnoid hemorrhage, its rupture can cause high morbidity and mortality. Surgical clipping and endovascular therapy treatment are the two main methods of treatment of intracranial aneurysms; Aneurysmal Subarachnoid Hemorrhage International Test (ISAT) Collaborative Group take a multi-center randomized trial in 2003,it results show that, for the same time amenable to surgical clipping and endovascular treatment of ruptured cerebral aneurysms treated patients, according to a disability-free survival after treatment to determine the clinical outcomes, endovascular treatment group was significantly better than the surgical group. But in recent years many studies have shown that surgical clipping and interventional treatment difference was not statistically significant curative effect.Objective Compare complications of cerebral vasospasm, the incidence of hydrocephalus, 6-month survival of the state, the recurrence rate in patients with anterior circulation with surgical clipping and endovascular treatment, to take the evaluation of two treatments. Methods:Take a retrospective analysis of the former First Affiliated Hospital of Xinxiang Medical College from January 2009 to June 2011 of 367 cases treated by the head of CTA or cerebral angiography-DSA diagnosed patients with intracranial aneurysms. Of which there are 301 cases in surgical group.66 cases in the intervention group; 161 male cases.206 female cases; anterior cerebral artery aneurysms 150 cases. cerebral artery aneurysm 76 cases, internal carotid artery aneurysm 141 cases, a total of 424 ruptured aneurysms; The timing of treatment patients were divided into three periods. (1) Surgical clipping or endovascular treatment were always be taken in the 72 hours after the rupture of intracranial aneurysm:(2) if it had been more than 72 hours. unless some patients whose condition varies, the remaining patients try to avoid the treatment after 4-10 days of treatment lines. (3)The remaining patients underwent surgery 10 days after the onset of clipping or endovascular therapy treatment.Surgical clipping treatment groups:Patients were taken pterion or expand pterional, under a powerful microscope,carefully separated lateral fissure, open adjacent brain cell to release of cerebrospinal fluid to reduce intracranial pressure, revealing the aneurysm, select the appropriate separation of aneurysm neck aneurysm clips aneurysm. All the patients were intubated using inhalation anesthesia, strictly maintain stable blood pressure, according to the aneurysm site is different, choose a different surgical approach, under a powerful microscope operating line aneurysm neck clipping. In order to determine the location of aneurysm clip is good, all perforator vessels and nerves around the clip were careful explored; If it had possible to formate artery stenosis or occlusion insufficiency, fluorescence imaging under microscope would be taken; For larger aneurysm, there may be compression symptoms, the body of aneurysm would be resect. Found on the skull base surgery adhesions heavier, carefully separated tissue adhesions, take endplate colostomy at the same time, in order to reduce the probability of occurrence of hydrocephalus. If the patient has lower preoperatively Hunt-Hess grade, lesser, brain edema, tight suture meninges, reset the bone; If the patient had high preoperative Hunt-Hess grade, heavier intraoperative brain edema, artificial dural suture dura, decompress craniectomy. Intervention group:general anesthesia and under systemic heparin anticoagulation, maintain continuous irrigation saline within the catheter to prevent thrombosis, the first line through the femoral artery cerebral angiography, to fully understand the situation and cerebrovascular circulation aneurysms the location, size, orientation, shape and relationship with the surrounding blood vessels, to select the best working angle accurately, measure the diameter of the aneurysm and the aneurysm neck width, within the guiding catheter through the ipsilateral carotid artery, ultra-election after suitable shaping microcatheter into the aneurysm cavity. Two groups were compared by sex. age, aneurysm size, aneurysm location, Hunt-Hess grade; Compare postoperative complications such as cerebral vasospasm, hydrocephalus et al:Compare patients modified Rankin score of six months after surgery related to Hunt -Hess grading:Contrast same preoperative Hunt-Hess grade of surgical clipping and endovascular treatment groups’ modified Rankin score of patients with the intervention group:Patients of surgical clipping review head CTA before discharge, the two groups patients reviewed DSA in 6 months, then every 6 months to 12 months follow-up, review DSA, followed up 9-33 months to aneurysm recurrence rate between the two groups of patients after surgery; Compare the average number of days in hospital of the two group.Result1. Of surgical clipping and endovascular treatment groups of patients the incidence of postoperative cerebral vasospasm, hydrocephalus and other major complications, has no significant difference in the statistical analysis, P> 0.05.2. Relationship between preoperative Hunt-Hess grade and the postoperative six months modified Rankin score:The statistical results showed that when patients had lower preoperatively Hunt-Hess grade, the modified Rankin score after 6 month lower; when preoperative Hunt-Hess grade high, the modified Rankin score after 6 month also increased, P<0.05.3. On the same preoperative Hunt-Hess grade levels.the patients 6 months modified Rankin score were treated with surgical clipping and endovascular surgery:The results showed that when the preoperative Hunt-Hess grade level had the same level, the modified Rankin score of two groups by statistical analysis P values were I grade (P= 0.21), II grade (P= 0.79), III grade (P= 0.99), all were greater than 0.05, it indicating that the modified Rankin score between the two groups of patients after treatment is no statistically significant.4. Surgical clipping group and endovascular group postoperative outpatient follow-up review 9-33 months, at an average of 17 months,12 patients with recurrent aneurysms; where there is a craniotomy after clipping relapse (due to occlusion insufficiency), the recurrence rate of 0.3%; endovascular embolization after 11 recurrence rate of 16.70%. Surgical clipping group and endovascular group differ in relapse rates between the two groups of applications χ2 test. Surgical clipping group recurrence rate was significantly lower than the intervention group, the difference was statistically significant (P<0.05).5. The number of patients treated with surgical clipping average hospital stay was 17.4±3.8 days, the average number of days of hospitalization in patients treated with endovascular was 12.8 ± 2.9 days, the endovascular group less than surgical clipping group, the results were statistically significant differences (P<0.05).Conclusion1. Surgical clipping and endovascular treatment of aneurysm rupture therapy odds are low, two treatments in the incidence of postoperative cerebral vasospasm and hydrocephalus influence has no significant difference.2. Surgical clipping and endovascular treatment effect on the prognosis of patients with no significant difference. Preoperative Hunt-Hess grade on the prognosis of patients significantly affected.3. Surgical clipping of the aneurysm treatment had lower relapse rate endovascular treatment, and endovascular treatment can shorten the hospital stay.4. Patients with intracranial aneurysms of anterior circulation, for young patients, good physical condition, it is recommended to select surgical clipping treatment, in order to be more exact effect; for elderly patients older than 65 years of age, poor physical condition, it is recommended to select intravascular intervention, in order to reduce the risk of postoperative complications in bed. |
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