| Objective: To retrospectively analyze the clinical outcome of ruptured intracranial aneurysms(≤4 mm)treated by interventional embolization or craniotomy.The curative effect,advantages and disadvantages of the two treatment methods were also compared to provide relevant theoretical basis for the clinical practice and scientific research.Method:1.Research objects Data of patients with ruptured aneurysm(n=511)in small aneurysms(≤4 mm)vist Guangzhou General Hospital of Wuhan military command from October 2010 to October2015 were collected.Patients were treated with interventional embolization(n=261)or craniotomy(n=250).Inclusion criteria:(1).By CT or lumbar puncture confirmed SAH;(2).DSA-3D double plate rotation angiography confirmed the maximum aneurysm diameter less than 4 mm;(3).Multiple aneurysms were mainly caused by aneurysm subarachnoid hemorrhage.All cases were discussed by both neurosurgery and interventional physicians before surgery and intervention,and informed consent was signed by patient or authorized agent.2.Major equipment and technology The German company SIEMENS Artis Zee biplane DSA System syngo double plate machine,X-WP 3D postprocessing system,conventional DSA image acquisition,through the internal carotid artery,external carotid arteryand vertebral artery were given contrast agent,3 ml/s of ICA(total 18 ml),VA 2.5 ml/s(total 15 ml),using "5s DSA" model,automatic image transmission to the 3D postprocessing system for measurement of aneurysm and the aneurysm site.3.Statistical analysis SPSS19.0 was used,data were presented as means ± SD or percentage.Comparisons between groups were performed by T test and categorical data using chi square test(or Fisher exact probability analysis),and multiple samples nonparametric test rank sum test using Kruskal-Wallis.The test level was =0.05,and the test level was P < 0.05.Results: Interventional group(n=261),gender: male(n=105,40.0%),female(n=156,60.0%);age 52.65 ± 10.4 years,smoking(n=40,15.3%),hypertension(n=118,42.5%),coronary heart disease(n=9,3.4%),diabetes(n=16,6.1%),preoperative hydrocephalus(n=39,14.9%),onset to treatment time was 2.69 ± 4.7 days,admission Hunt-Hess 1-3grade(n=214,82.1%),4-5 grade(n=47,17.9%),Fisher(n=165,63.2%)0-2 grade,3-4grade(n=96,36.8%),aneurysms located at the front(n=240,92%),aneurysms located at posterior circulation(n=21,8%),narrow neck width(n=67,25.7%),wide neck width(n=194,74.3%).Clipping(n=250),gender: male(n=96,38.4%),female(n=154,61.6%),age 52.79 ± 9.6 years,smoking(n=37,14.8%),hypertension(n=101,40.4%),coronary heart disease(n=8,3.2%),diabetes(n=10,4.0%),preoperative hydrocephalus(n=37,14.8%),onset to treatment time was 2.52 ± 3.6 days,admission Hunt-Hess 1-3 grade(n=192,76.8%),4-5 grade(n=58,23.2%),Fisher 0-2 grade(n=150,60.0%),3-4 grade(n=100,40.0%),aneurysm located in the anterior circulation(n=234,93.6%),after cycles(n=16,6.4%),narrow neck(n=88,35.2%),wide neck(n=162,64.8%).The clinical results at 1 years of follow-up in the intervention group: m RS 0-2(n=187,71.6%),disability(m RS 3-5,n=68,26.1%),death(m RS = 6,n=6,2.3%).The results of 1 years in craniotomy group(m RS 0-2,n=171,68.4%),disability(m RS 3-5,n=74,29.6%%),death(m RS = 6,n=5,2.0%).The recurrence rate in craniotomy group was 2.3%(n=6),but3.1%(n=8)in intervention group.There was no statistical difference on outcome between the two groups.The average cost of intervention group were 120527.5 ±48152.7 yuan,craniotomy group 121985 ± 55070.4 yuan,and there were no significant difference between the two groups.The average days of hospitalization of clipping group(16.99 ± 10.8 days)was shorter than craniotomy group(21.1 ± 11.6 days)(P<0.05).Conclusion: The main treatment the ruptured intracranial aneurysm(≤4mm)were craniotomy clipping and interventional embolization,and most of the current clinical center advocated interventional treatment.Our study found that: from the analysis of short-term study,there were no statistically significant between craniotomy clipping and interventional embolization on hospital expenses,postoperative recovery,postoperative complications and postoperative complications such as the assessment index except for everage hospitalization time.Thus,we summarize the following points: 1.With the development of interventional technology and material science,there were no i significant difference on safety between craniotomy clipping and interventional embolization;2.Due to the surgical trauma,faster postoperative recovery,interventional embolization will be accepted by much more medical staff and patients;3.For its small volume aneurysms and no difference on treatment costs,poor patients may pay much more attention on interventional embolization;4.Stent technology were used mainly in the aneurysms,for our limitation of short follow-up timen,a long-term observation of its function on patients is needed.In conclusion,interventional embolization will be dominant in the treatment of small aneurysms in the future. |
PDF Full Text Request