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
{"title":"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。","authors":"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","doi":"10.1016/j.neuchi.2024.101600","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, I<sup>2</sup> = 19%], and the conversion rate from an awake-induced anesthesia protocol to general anesthesia was 1% [95%CI, 0.00−0.05, I<sup>2</sup> = 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, I<sup>2</sup> = 0%]. The transient postoperative symptomatic event rate was 34% [95%CI, 0.06−0.81, I<sup>2</sup> = 77%]. The overall morbidity rate was 4% [95%CI, 0.00−0.09, I<sup>2</sup> = 0%], and the overall mortality rate was 0% [95%CI, 0.00−0.03, I<sup>2</sup> = 0%].</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101600"},"PeriodicalIF":1.5000,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Awake microsurgical management of brain aneurysms: a comprehensive systematic review and meta-analysis on rationale, safety and clinical outcomes\",\"authors\":\"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\",\"doi\":\"10.1016/j.neuchi.2024.101600\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, I<sup>2</sup> = 19%], and the conversion rate from an awake-induced anesthesia protocol to general anesthesia was 1% [95%CI, 0.00−0.05, I<sup>2</sup> = 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, I<sup>2</sup> = 0%]. The transient postoperative symptomatic event rate was 34% [95%CI, 0.06−0.81, I<sup>2</sup> = 77%]. The overall morbidity rate was 4% [95%CI, 0.00−0.09, I<sup>2</sup> = 0%], and the overall mortality rate was 0% [95%CI, 0.00−0.03, I<sup>2</sup> = 0%].</div></div><div><h3>Conclusion</h3><div>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. 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Awake microsurgical management of brain aneurysms: a comprehensive systematic review and meta-analysis on rationale, safety and clinical outcomes
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.
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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