Comparative Analysis Of Interventional Embolization And Craniotomy Clipping For Intracranial Aneurysm In Tibet Area

Background Intracranial aneurysm(IA)is one of the most common and frequent diseases in brain surgery.Aneurysm rupture can lead to subarachnoid hemorrhage(SAH),which has a high incidence,rapid progression and severe symptoms.It is often accompanied by intracranial hematoma,which leads to severe cerebral hernia,leading to a significant increase in disability and mortality.There are two main methods of clinical surgical treatment:craniotomy and vascular interventional embolization.Catheter interventional embolization has smaller incision and higher safety than craniotomy.However,it has been controversial whether it has the same advantages in terms of length of operation,length of stay,cost of hospitalization and effect after operation.Purpose To analyze whether there are significant differences in related factors and therapeutic effects among patients with middle cerebral artery aneurysm(MCAA)in different treatment methods,and to provide new evidence for clinical treatment.Method A retrospective analysis was made of 55 patients with MCAA admitted to the neurosurgery department of the People's Hospital of Tibet Autonomous Region from June 2013 to June 2018.Among them,12 were treated with interventional embolization and 43 with craniotomy and clipping.Basic information including gender,age,systolic blood pressure(SBP),diastolic blood pressure(DBP),and history of hypertension were collected.T test(numerical variable)or chi-square test(classification variable)were used to explore whether the prognostic effect of MCAA patients was affected by the above factors.2.Hospitalization information,including length of operation,hospitalization expenses,hospitalization time,etc.GOS score was used to evaluate the recovery and prognosis of MCAA patients.T test was used to compare the clinical efficacy of interventional embolization and craniotomy clipping in MCAA patients.Result There were 55 patients in total.Univariate analysis showed that gender(?~2=0.23,P=0.808),age(t=0.10,P=0.963),history of hypertension(?~2=8.22,P=0.251)had no significant difference,while systolic blood pressure(t=-2.66,P=<0.001),diastolic blood pressure(t=-3.25,P<0.001)were the prognostic factors.From the statistical operation time,we can see that the operation time of craniotomy group was(3.45±1.08)h,and that of interventional group was(3.45±1.08)h,P<0.001.This shows that there is a significant difference between the two groups,and the operation time of interventional embolization is shorter.From the statistics of hospitalization expenses,we can see that the total hospitalization expenses of craniotomy group were(96.3±17.5)thousand yuan,and those of interventional group were(169.4±27.8)thousand yuan,,P<0.001.This shows that there is a significant difference between the two groups,and the hospitalization costs of interventional embolization treatment are higher.According to the statistics of hospitalization days,the average hospitalization days in craniotomy group and interventional group were(24.40±2.10)days and(14.24±2.65)days respectively.T test was used in comparison between the two groups,P<0.001,indicating that there was a significant difference between the two groups,and the hospitalization days treated by interventional embolization were fewer.Comprehensive analysis showed that the prognosis of MCAA(hematoma<30ml)patients treated with interventional embolization was better than that of patients treated with craniotomy clipping(GOS score:t=3.85,P=2.22×10-4),with lower complication rate,shorter operation time and fewer hospital days,but the cost was relatively high.Conclusion1.Systolic blood pressure and diastolic blood pressure are the prognostic factors of MCAA.2.MCAA interventional embolization is expensive,but the patients have shorter operation time and fewer hospitalization days.3.MCAA(hematoma<30ml)interventional embolization is superior to craniotomy clipping.