| BackgroundCerebrovascular disease is currently a common disease seriously endangering people’s health and quality of life due to its high morbidity,high mortality and high disability.It also becomes an important public health problem because it put a financial and social burden to the patients self,the caregivers and the country.Rupture of intracranial aneurysm is one of the leading diseases in cerebrovascular disease,right after cerebral thrombosis and hypertensive intracerebral hemorrhage.Intracranial aneurysms mostly occur in the branch of the cerebral artery,bifurcation or sharp turns and adjacent areas,especially in the Willis ring region.Once intracranial aneurysms rupture and are not given timely treatment,intracranial aneurysms are prone to re-bleed.Therefore,timely surgical treatment of ruptured aneurysms is critical to prevent re-bleed.At present,intracranial aneurysms are treated with craniotomy and interventional embolization.Craniotomy is the main treatment mode in recent 50 years.With the application of surgical microscope,micro surgical techniques and instruments development,success rate of craniotomy is significantly improved and the incidences of complications are dramatically reduced.Interventional embolization arose in the 1970s and has become an important method of treatment of aneurysms.Of course,with the improvement of the interventional technology and embolic material,it is wildly accepted by the patient and the neurosurgeons.However,the two surgical methods have different shortcomings.Craniotomy has higher incidence of causing trauma or damage to the brain tissue,infection and other complications.Difficulty and limitation of treating deep aneurysm still exist.Intervention embolization is relatively less invasive,less trauma to the brain tissue,but a greater vascular stimulation,may lead to vasospasm or occlusion,coil shift and other complications.Nevertheless the cost of intervention embolization is much higher than traditional craniotomy.At present,most of the hospitals are performing both surgical interventions.With the current improvement of living standards and the continuous improvement of health insurance,economic issues are not the key factors to consider when it comes to the choice of the surgery.The patients and families are focusing more on outcomes of the surgery.Craniotomy and interventional embolization have no significant difference in the efficacy,but interventional embolism normally results in the shorter hospital stay and the patient experiences less pain.The majority of patients prefer minimally invasive surgery.However,it is hard to make final conclusion on the above theory due to the lack of large clinical cases.Therefore,this article summarizes all the surgical clinical cases in our hospital in the recent 4 years,who went under either craniotomy or intervention embolization for ruptured intracranial aneurysms.Based on our analysis of the effect of craniotomy or intervention embolization,we hope to provide the basis view to the criteria of clinical development of choosing appropriate treatment of ruptured intracranial aneurysms.Research purposes1.To discuss the preoperative preparation,operation,postoperative complications and prognosis of craniotomy and interventional embolization of intracranial aneurysms,analyze and summarize the treatment effect.2.To compare the advantages and disadvantages of the two,for the clinical treatment of surgical options on the choice of reference.Materials and MethodsThe subjects were the patients undergoing intracranial aneurysm surgery between July 2011 and July 2015 at Department of Neurosurgery,Yantai Affiliated Hospital of Binzhou Medical College.In this study,102 subjects were selected,of which 52 cases were the group,who were treated with craniotomy.The other group consisted 50 cases,who were treated with minimally invasive interventional embolization.We include the following pre-operative criteria into consideration:the patients’ age,sex,medical history such as diabetes,hypertension and etc,Hunt-Hess classification,GCS scores and etc.Every patient will have a post-operative follow up visit in one month.The observed indicators include Modified Rankin Scale(MRS)at discharge,GCS score(two weeks post-operative),length of hospital stay,total cost of hospitalization,mortality and the incidence of cerebral vasospasm,cerebral infarction,intracranial infection and pulmonary infection in a month.Generalized linear regression analysis and logistic regression analysis were used to control possible confounders and to explore the influencing factors of numerical variables.Research resultThe preoperative data shows the patients in craniotomy group were younger than interventional embolization group(p= 0.005),The number of patients with the urban residents insurance was higher than that with interventional embolization group(p =0.037).The patients in craniotomy group were more critical comorbidity condition than those in interventional embolization group such as higher incidence of hypertension(p = 0.058),higher Hunt-Hess score(p = 0.014),lower preoperative GSC score(p = 0.003).There were many post-operative observed indicators for patients in craniotomy,such as stay hospital was 23.81 ±4.78 days,total cost of hospitalization was 67.1 ±12.9 thousand yuan,GCS score was 13.33 ±3.07,the MRS was 0 score 22 patients(42.3%),1 score 11 patients(21.2%),Greater than or equal to 2 score 19 patients(36.5%),and complications had 13 patients(25.0%).The patients in interventional embolization group,stay hospital was 18.58 ±3.69 days,total cost of hospitalization was 12.3 ±3.79 thousand Yuan,GCS score was 14.37± 1.38,the MRS was 0 score 27 patients(54.0%),1 score 17 patients(34.0%),Greater than or equal to 2 score 6 patients(12.0%),and complications had 6 patients(12.0%).The postoperative data showed that the patients in craniotomy group were higher complication rate than that in interventional embolization group(p=0.092),and lower GCS score(p=0.034),longer hospital stay(p<0.001),lower total cost(p<0.001),higher post-operative MRS(p=0.014).After changing the preoperative variables,there was no significant difference in the postoperative GCS scores between the craniotomy group and the intervention group(p = 0.838).There was no significant difference between the craniotomy group and the intervention group in the postoperative complication rate(p = 0.540).There was no significant difference in the MRS between the craniotomy group and the intervention group.But,there was significant difference in hospital stay and total cost.The patients in craniotomy group were longer hospital stay(5.6 days)(p<0.001)and lower total cost(49 thousand Yuan)(p<0.001)than that in interventional embolization group.ConclusionThis study shows that the craniotomy and interventional embolization have no significant difference in efficiency.Patients can choose the most appropriate surgical treatment based on their own circumstances while keeping in mind that craniotomy may result in long hospital stay and interventional embolization may cost more. |
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