The Classification Of Intracranial Aneurysm Neck: A Single Center Research Experience

Objective:There is associating with incidence of unfavorable outcomes compared to microsurgical clippings.we are in order to investigate the outcomes of microsurgical clipping for intracranial aneurysms and determine the ideal clipping methods for different aneurysm subtypes.Method:In this retrospective study,From October 2013 to October 2016,There are 123 patients with 128 aneurysms were treated by experienced neurosurgeons in Department of Neurosurgery,the First Affiliated Hospital of Fujian Medical University.Among them,20 cases of aneurysms were treated from October 2013 to December 2013,and the patients were treated as control group.In January 2014,aneurysms were classified base on the 20 cases of aneurysm imaging data.From January 2014 to October 2016,103 patients were treated as experimental group,according to the imaging data of the patients in the experimental group,the classification of aneurysms previously proposed was used to estimate the way of surgery,and the guiding value of the genotype was verified according to the intraoperative findings.The proposed aneurysm classification is based on the virtual surface of the aneurysm and the parent artery,the aneurysm neck was classified as follows: subtype I,the curved surface of the neck is a single curved surface;subtype II,the curved surface of the neck is hyperboloid;subtype III,the curved surface of the neck is a three-curved surface.Aneurysms were divided into further subtypes according to the ratio of the width of the aneurysm neck surface and the length of the artery circumference: subtype A,the ratio of the aneurysm neck surface to the parent artery was not more than 0.5;subtype B,the ratio of the aneurysm neck surface to the parent artery was more than 0.5.There are some clamping methods include simple,sliding,interlocking and hybrid.Base on the classification of aneurysm,whether to change the way of clamping in the surgery by the surgeon decide the actual situation to determine.Results: There are different suitable ways for different types of aneurysms,patients who were treated by classification of aneurysms were scheduled in a reasonable way to trap the intracranial aneurysms.In the control group,patients did not undergo a suitable clipping scheme without classification of aneurysm neck(unclassed clipping).Only base on experience and judgment by the neurosurgeon,who obtain the aneurysm position and size from the preoperative CTA or DSA.(There may be not match between preoperative scheduled aneurysm clip program and the actual situation),while causing the occurrence of occlusion adverse events,including neck residual,Tumor artery stenosis,electrophysiological changes,the lack of blood supply and so on.The experimental group was analyzed by using a predetermined clipping scheme(classed clipping),and the use of aneurysms clamps was approximately the same as expected.(There were match between preoperative scheduled aneurysm clip program and the actual situation).In the 123 patients,128 aneurysms were treated by microscopic,with a 100% clipping and an incidence of adverse events of 1.1%.Among them,103 patients were diagnosed and treated by classification.A total of 108 aneurysms were selected.20 patients were not clipping by the classification.Compared the preoperative assessment with the actual situation,the consistency of the control group was 50% and the experimental group was 96%.Adverse events of classed clipping is 2 %,another is 60%.There is a significant difference between the two groups(P <0.05).Classed clipping of subject ?A and ?B are simple(mean 1.2 and 1.3 clips);classed clipping of subject ?A is simple and interlocking(mean 1.2 clips);classed clipping of subject?B is sliding and hybrid(mean 2.05 clips);classed clipping of subject ?A and ?B are hybrid(mean 2.3 clips).Conclusion: There is a higher consistency in surgery through the above classification of preoperative assessment of clipping.There was no adverse event of intracranial aneurysm clipping in the clipping mode selected by the above classification,and satisfactory surgical clipping rate was achieved and no recurrence was found.