Awake microsurgical management of brain aneurysms: a comprehensive systematic review and meta-analysis on rationale, safety and clinical outcomes.

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY Neurochirurgie Pub Date : 2024-10-03 DOI:10.1016/j.neuchi.2024.101600

Jhon E Bocanegra-Becerra, Gabriel Simoni, Cristian D Mendieta, José Luis Acha Sánchez, Lucca B Palavani, Kim Wouters, Anuraag Punukollu, Gabriel Mangas, Raphael Bertani, Miguel Angel Lopez-Gonzalez

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Abstract

Introduction: Awake microsurgery for brain aneurysm treatment has emerged as a tool for real-time intraoperative monitoring, opportune detection of ischemic complications, and reduction of surgical morbidity. Herein, we aimed to explore the current state of the procedure's rationale, safety and clinical outcomes.

Methods: In accordance with PRISMA guidelines, five databases were queried for articles reporting awake microsurgical management of brain aneurysms. Aggregate study results were combined using random-effects meta-analyses. Publication bias was evaluated through funnel plot analysis and Egger's regression test.

Results: Out of 847 articles, 11 records satisfied the inclusion criteria. Seventy-five patients (68% female) with 75 brain aneurysms (68% unruptured) were analyzed. Clipping was the predominant technique (58%), followed by bypass (17%). Monitored anesthesia care was the principal anesthesia protocol (60%). The incidence of anesthesia-related complications was 1% [95%CI, 0.00-0.05, I² = 19%], and the conversion rate from an awake-induced anesthesia protocol to general anesthesia was 1% [95%CI, 0.00-0.05, I² = 0%]. No permanent anesthesia-related morbidity and mortality was reported. Complete aneurysm repair, occlusion and bypass patency rate was 100% [95%CI, 0.96-1.00, I² = 0%]. The transient postoperative symptomatic event rate was 34% [95%CI, 0.06-0.81, I² = 77%]. The overall morbidity rate was 4% [95%CI, 0.00-0.09, I² = 0%], and the overall mortality rate was 0% [95%CI, 0.00-0.03, I² = 0%].

Conclusion: Awake microsurgery of brain aneurysms is feasible, yet current evidence stems from observational studies. This procedure can reduce surgical morbidity by providing accurate and real-time neurological monitoring during aneurysm repair. While this technique appears to be tolerated, higher level evidence is needed to evaluate judiciously its safety and preference over existing practices for intraoperative neurological monitoring.

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脑动脉瘤的清醒显微手术治疗：关于原理、安全性和临床结果的全面系统回顾和荟萃分析。

导言：用于脑动脉瘤治疗的清醒显微手术已成为术中实时监测、及时发现缺血并发症和降低手术发病率的一种工具。在此，我们旨在探讨该手术的原理、安全性和临床结果的现状：根据 PRISMA 指南，我们在五个数据库中查询了报道脑动脉瘤清醒显微手术治疗的文章。采用随机效应荟萃分析法合并研究结果。通过漏斗图分析和 Egger 回归检验评估了发表偏倚：在847篇文章中，有11篇符合纳入标准。对75例脑动脉瘤患者（68%为女性）（68%未破裂）进行了分析。夹闭是最主要的技术（58%），其次是搭桥（17%）。监测麻醉护理是主要的麻醉方案（60%）。麻醉相关并发症的发生率为1% [95%CI, 0.00-0.05, I2 = 19%]，从清醒麻醉方案转为全身麻醉的发生率为1% [95%CI, 0.00-0.05, I2 = 0%]。没有永久性麻醉相关发病率和死亡率的报告。动脉瘤完全修复、闭塞和旁路通畅率为100% [95%CI, 0.96-1.00, I2 = 0%]。术后一过性症状发生率为 34% [95%CI, 0.06-0.81, I2 = 77%]。总发病率为4% [95%CI, 0.00-0.09, I2 = 0%]，总死亡率为0% [95%CI, 0.00-0.03, I2 = 0%]：结论：脑动脉瘤的清醒显微手术是可行的，但目前的证据来自观察性研究。该手术可在动脉瘤修复过程中提供准确、实时的神经监测，从而降低手术发病率。虽然这种技术似乎是可以忍受的，但还需要更高水平的证据来明智地评估其安全性以及与现有术中神经监测方法相比的优越性。

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来源期刊

Neurochirurgie 医学-临床神经学

CiteScore

2.70

自引率

6.20%

发文量

100

审稿时长

29 days

期刊介绍： Neurochirurgie publishes articles on treatment, teaching and research, neurosurgery training and the professional aspects of our discipline, and also the history and progress of neurosurgery. It focuses on pathologies of the head, spine and central and peripheral nervous systems and their vascularization. All aspects of the specialty are dealt with: trauma, tumor, degenerative disease, infection, vascular pathology, and radiosurgery, and pediatrics. Transversal studies are also welcome: neuroanatomy, neurophysiology, neurology, neuropediatrics, psychiatry, neuropsychology, physical medicine and neurologic rehabilitation, neuro-anesthesia, neurologic intensive care, neuroradiology, functional exploration, neuropathology, neuro-ophthalmology, otoneurology, maxillofacial surgery, neuro-endocrinology and spine surgery. Technical and methodological aspects are also taken onboard: diagnostic and therapeutic techniques, methods for assessing results, epidemiology, surgical, interventional and radiological techniques, simulations and pathophysiological hypotheses, and educational tools. The editorial board may refuse submissions that fail to meet the journal''s aims and scope; such studies will not be peer-reviewed, and the editor in chief will promptly inform the corresponding author, so as not to delay submission to a more suitable journal. With a view to attracting an international audience of both readers and writers, Neurochirurgie especially welcomes articles in English, and gives priority to original studies. Other kinds of article - reviews, case reports, technical notes and meta-analyses - are equally published. Every year, a special edition is dedicated to the topic selected by the French Society of Neurosurgery for its annual report.