Brandon Edelbach, Ha Yeon Lee, Miguel Angel Lopez-Gonzalez
{"title":"对巨型纺锤形马氏动脉瘤破裂的血管内治疗和显微外科治疗进行系统回顾和比较分析，并附有病例说明。","authors":"Brandon Edelbach, Ha Yeon Lee, Miguel Angel Lopez-Gonzalez","doi":"10.1016/j.neuchi.2024.101601","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Despite advances in neurosurgical techniques and technology, the management of ruptured giant fusiform MCA aneurysms remains challenging. In the literature, microsurgical intervention is the most commonly described approach. However, recent advancements in endovascular techniques have expanded therapeutic options and as a result there is no consensus on the optimal management of these aneurysms.</p><p><strong>Methods: </strong>A literature search was performed through the PubMed, Google Scholar, and Embase databases, for surgical and endovascular management of ruptured giant fusiform MCA aneurysms. Inclusion criteria included: fusiform morphology, hemorrhage, major diameter greater than 2.5 cm and located along the MCA.</p><p><strong>Results: </strong>Literature review yielded 21 studies published from 1981 to 2023 and a total of 32 patients ages 33.40 ± 18.28. The male to female ratio was 1.9:1. The average Hunt and Hess score upon presentation in the total population was 2.78 ± 1.48, and the average pre-operative mRS of the total population was 2.75 ± 1.83. The average major diameter was 3.80 ± 1.85 cm. Average follow-up was 8.9 ± 9.74 months. There was no statistical difference in age (p = 0.5609), pre-operative mRS (p = 0.2355), Hunt and Hess scale (p = 0.183), aneurysm major diameter (p = 0.594) or follow-up (0.8922) between the two modalities. There was no significant difference in clinical outcome between microsurgical and endovascular intervention, nor was there a significant difference when stratified according to sex, major diameter, or location along the MCA. Two case examples are presented after management with cerebral revascularization.</p><p><strong>Conclusion: </strong>Our analysis underscores the absence of statistical differences in clinical outcomes between microsurgical and endovascular strategies for ruptured giant fusiform MCA aneurysms, which highlights the need for complex surgical revascularization as represented on the illustrative cases where no endovascular option was available.</p>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Systematic review and comparative analysis of endovascular and microsurgical management of giant ruptured fusiform mca aneurysms with illustrative cases.\",\"authors\":\"Brandon Edelbach, Ha Yeon Lee, Miguel Angel Lopez-Gonzalez\",\"doi\":\"10.1016/j.neuchi.2024.101601\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite advances in neurosurgical techniques and technology, the management of ruptured giant fusiform MCA aneurysms remains challenging. In the literature, microsurgical intervention is the most commonly described approach. However, recent advancements in endovascular techniques have expanded therapeutic options and as a result there is no consensus on the optimal management of these aneurysms.</p><p><strong>Methods: </strong>A literature search was performed through the PubMed, Google Scholar, and Embase databases, for surgical and endovascular management of ruptured giant fusiform MCA aneurysms. Inclusion criteria included: fusiform morphology, hemorrhage, major diameter greater than 2.5 cm and located along the MCA.</p><p><strong>Results: </strong>Literature review yielded 21 studies published from 1981 to 2023 and a total of 32 patients ages 33.40 ± 18.28. The male to female ratio was 1.9:1. The average Hunt and Hess score upon presentation in the total population was 2.78 ± 1.48, and the average pre-operative mRS of the total population was 2.75 ± 1.83. The average major diameter was 3.80 ± 1.85 cm. Average follow-up was 8.9 ± 9.74 months. There was no statistical difference in age (p = 0.5609), pre-operative mRS (p = 0.2355), Hunt and Hess scale (p = 0.183), aneurysm major diameter (p = 0.594) or follow-up (0.8922) between the two modalities. There was no significant difference in clinical outcome between microsurgical and endovascular intervention, nor was there a significant difference when stratified according to sex, major diameter, or location along the MCA. Two case examples are presented after management with cerebral revascularization.</p><p><strong>Conclusion: </strong>Our analysis underscores the absence of statistical differences in clinical outcomes between microsurgical and endovascular strategies for ruptured giant fusiform MCA aneurysms, which highlights the need for complex surgical revascularization as represented on the illustrative cases where no endovascular option was available.</p>\",\"PeriodicalId\":51141,\"journal\":{\"name\":\"Neurochirurgie\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurochirurgie\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.neuchi.2024.101601\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurochirurgie","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.neuchi.2024.101601","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Systematic review and comparative analysis of endovascular and microsurgical management of giant ruptured fusiform mca aneurysms with illustrative cases.
Background: Despite advances in neurosurgical techniques and technology, the management of ruptured giant fusiform MCA aneurysms remains challenging. In the literature, microsurgical intervention is the most commonly described approach. However, recent advancements in endovascular techniques have expanded therapeutic options and as a result there is no consensus on the optimal management of these aneurysms.
Methods: A literature search was performed through the PubMed, Google Scholar, and Embase databases, for surgical and endovascular management of ruptured giant fusiform MCA aneurysms. Inclusion criteria included: fusiform morphology, hemorrhage, major diameter greater than 2.5 cm and located along the MCA.
Results: Literature review yielded 21 studies published from 1981 to 2023 and a total of 32 patients ages 33.40 ± 18.28. The male to female ratio was 1.9:1. The average Hunt and Hess score upon presentation in the total population was 2.78 ± 1.48, and the average pre-operative mRS of the total population was 2.75 ± 1.83. The average major diameter was 3.80 ± 1.85 cm. Average follow-up was 8.9 ± 9.74 months. There was no statistical difference in age (p = 0.5609), pre-operative mRS (p = 0.2355), Hunt and Hess scale (p = 0.183), aneurysm major diameter (p = 0.594) or follow-up (0.8922) between the two modalities. There was no significant difference in clinical outcome between microsurgical and endovascular intervention, nor was there a significant difference when stratified according to sex, major diameter, or location along the MCA. Two case examples are presented after management with cerebral revascularization.
Conclusion: Our analysis underscores the absence of statistical differences in clinical outcomes between microsurgical and endovascular strategies for ruptured giant fusiform MCA aneurysms, which highlights the need for complex surgical revascularization as represented on the illustrative cases where no endovascular option was available.
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.
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