1
|
Li M, Tian Z, Ru X, Shen J, Chen G, Duan Z, Cui J. Comparison of endovascular interventional embolization and microsurgical clipping for ruptured cerebral aneurysms: impact on patient outcomes. Int J Neurosci 2024:1-8. [PMID: 38189419 DOI: 10.1080/00207454.2024.2303369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To compare the therapeutic efficacy of endovascular interventional embolization and microsurgical clipping in patients with ruptured cerebral aneurysms and investigate their subsequent influence on inflammatory indices, neurological function, prognosis, and recovery. METHODS The two groups were compared in terms of surgery duration, hospital stay, Hunt-Hess classification, and inflammatory indices before and after the surgery, as well as National Institutes of Health Stroke Scale (NIHSS), Baethel Index (BI), and one-year prognosis of patients affected. RESULTS The surgery duration and hospital stay of the intervention group were (116.27 ± 12.32) min and (19.82 ± 2.26) d, respectively, and those of the clipping group was (173.87 ± 10.39) min and (24.11 ± 2.33) d, respectively (both p < 0.05). Neither the intervention nor the microscopic approach had a significant impact on the severity of the patients' conditions in terms of Hunt-Hess classification (p > 0.05). In the intervention group, CRP was changed to (5.31 ± 1.22) mg/L and PCT decreased to (1.17 ± 0.39) μg/L after the surgery, while the corresponding values in clipping group were (9.78 ± 2.35) mg/L and (2.75 ± 0.81) μg/L (p > 0.05). After surgery, both groups' NIHSS scores declined dramatically, with the intervention group scoring lower than the microscopy group (6.81 ± 1.22 vs 8.72 ± 1.27) (p < 0.05). CONCLUSION The findings of this study support the potential advantages of endovascular interventional embolization (coiling) over microsurgical clipping for the management of ruptured cerebral aneurysms. These advantages include shorter surgical duration, reduced hospital stay, lower inflammatory response, improved neurological and functional outcomes, and better long-term prognosis.
Collapse
Affiliation(s)
- Min Li
- Department of Neurosurgery, Jincheng People's Hospital, Jincheng, Shanxi Province, China
| | - Zhihua Tian
- Department of Neurosurgery, Jincheng People's Hospital, Jincheng, Shanxi Province, China
| | - Xiaohong Ru
- Department of Neurosurgery, Jincheng People's Hospital, Jincheng, Shanxi Province, China
| | - Jianbo Shen
- Department of Neurosurgery, Jincheng People's Hospital, Jincheng, Shanxi Province, China
| | - Guiping Chen
- Department of Neurosurgery, Jincheng People's Hospital, Jincheng, Shanxi Province, China
| | - Zhibin Duan
- Department of Neurosurgery, Jincheng People's Hospital, Jincheng, Shanxi Province, China
| | - Jie Cui
- Department of Neurosurgery, Jincheng People's Hospital, Jincheng, Shanxi Province, China
| |
Collapse
|
2
|
Hirokawa Y, Michiwaki Y, Tanaka T, Kawashima M, Wakamiya T, Sashida R, Shimoji K, Suehiro E, Onoda K, Yamane F, Matsuno A. A complete thrombotic large aneurysm at the nonbranching segment of the distal anterior cerebral artery mimicking a cavernous malformation: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22433. [PMID: 36681972 PMCID: PMC9745585 DOI: 10.3171/case22433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Thrombotic aneurysms at the nonbranching segment of the distal anterior cerebral artery (ACA) are extremely rare and difficult to differentiate from cavernous malformations by radiographic features alone. OBSERVATIONS Computed tomography and magnetic resonance imaging of a 30-year-old female patient with a chronic headache complaint revealed a 22-mm frontal lobe mass. The mass showed heterogeneous mixed intensity and hemosiderin deposits on magnetic resonance images. It was not visualized by conventional angiography, indicating that the mass and ACA/other vessels were not connected. The patient was preoperatively diagnosed with a cavernous malformation. However, during resection, the mass surface was white and smooth, different from a cavernous malformation. Although the mass was adherent to the pericallosal artery branch, no luminal continuity was observed. After detachment, the mass was completely resected. Pathological and immunohistochemical findings indicated a vessel wall and interior thrombus. The patient was rediagnosed with a thrombotic aneurysm at the distal ACA nonbranching segment and discharged 10 days postsurgery without neurological deficits. LESSONS Because radiographic findings of thrombotic aneurysm and cavernous malformation are similar, mass lesions in contact with major arteries should be differentiated as thrombotic aneurysms, even when the artery lumen appears disconnected from the mass.
Collapse
Affiliation(s)
- Yu Hirokawa
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita City, Chiba, Japan
| | - Yuhei Michiwaki
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita City, Chiba, Japan
| | - Tatsuya Tanaka
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita City, Chiba, Japan
| | - Masatou Kawashima
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita City, Chiba, Japan
| | - Tomihiro Wakamiya
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita City, Chiba, Japan
| | - Ryohei Sashida
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita City, Chiba, Japan
| | - Kazuaki Shimoji
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita City, Chiba, Japan
| | - Eiichi Suehiro
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita City, Chiba, Japan
| | - Keisuke Onoda
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita City, Chiba, Japan
| | - Fumitaka Yamane
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita City, Chiba, Japan
| | - Akira Matsuno
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita City, Chiba, Japan
| |
Collapse
|