Comparison of microsurgical clipping and intravascular interventional embolization on nerve function recovery in patients with posterior communicating aneurysm combined with oculomotor paralyses / 中国医师杂志

Objective To compare the influences of microsurgical clipping and intravascular interventional embolization on the nerve function recovery in patients with posterior communicating aneurysm combined with oculomotor paralyses.Methods Eighty-six patients with posterior communicating artery aneurysm accompanied by oculomotor nerve palsy admitted to Qianjiang Central Hospital of Chongqing from May 2015 to May 2017 were randomly divided into observation group (n =43) and control group (n =43) by random number table method.The control group was treated with microsurgical clipping,while the observation group was treated with intravascular interventional embolization.The therapeutic effect,neurological function recovery,postoperative complications and prognosis of the two groups were compared.Results The operation time,intraoperative blood loss,postoperative respiratory recovery time and postoperative extubation time of the observation group were significantly less than those of the control group (P ＜ 0.05);the complete recovery of the observation group was significantly higher than that of the control group,and no recovery was significantly lower than that of the control group (P ＜ 0.05);the incidence of complications in the observation group was significantly lower than that in the control group (P ＜ 0.05);the proportion of 5 points in the observation group was significantly higher than that in the control group (P ＜ 0.05).Conclusions Intravascular interventional embolization in the treatment of posterior communicating aneurysm combined with oculomotor paralyses can promote the recovery of nerve function,reduce the incidence of postoperative complications,have a good prognosis and a definite effect,which can be used as the first choice of treatment.

Residual lesions in patients undergoing microsurgical clipping of cerebral aneurysms in a reference university hospital

OBJECTIVES: This study aimed to analyze the incidence and epidemiological, angiographic, and surgical aspects associated with incomplete clipping of brain aneurysms in a cohort of patients undergoing microsurgical treatment. METHODS: The medical record data of patients who underwent microsurgery for cerebral aneurysm treatment and postoperative digital subtraction angiography, treated at the same teaching hospital between 2014 and 2019, were retrospectively analyzed. The studied variables involved epidemiological and clinical data, as well as neurological status and findings on neuroimaging. The time elapsed between hemorrhage and microsurgical treatment, data on the neurosurgical procedure employed for aneurysm occlusion, and factors associated with the treated aneurysm, specifically location and size, were also evaluated. RESULTS: One hundred and seventeen patients were submitted to 139 neurosurgical procedures, in which 167 aneurysms were clipped. The overall rate of residual injury was 23%. Smoking (odds ratio [OR]: 3.38, 95% confidence interval [CI95%]: 1.372-8.300, p=0.008), lesion size >10 mm (OR: 5.136, CI95%: 2.240-11.779, p<0.001) and surgery duration >6 h (OR: 8.667, CI95%: 2.713-27.681, p<0.001) were found to significantly impact incomplete aneurysm occlusion in the univariate analyses. CONCLUSION: Incomplete microsurgical aneurysm occlusion is associated with aneurysm size, complexity, and current smoking status. Currently, there is no consensus on postoperative assessment of clipped aneurysms, hindering the correct assessment of treatment outcomes.

Foraminotomía optica para el clipado de aneurisma carótido-oftálmico superior / Optical foraminotomy for clipping of superior carotid-ophthalmic aneurysm

Introducción: Los aneurismas carótido-oftálmicos generalmente causan problemas visuales, y su tratamiento quirúrgico sigue siendo un reto debido al objetivo de preservar y/o mejorar la función visual. Descripción del caso: Presentamos caso de intervención quirúrgica de aneurisma carotídeo-oftálmico superior. Masculino de 64 años de edad con déficit de campo visual inferior izquierdo y cefalea. La reconstrucción angio-TC mostró un aneurisma carotídeo-oftálmico superior izquierdo no roto (4x5 mm). Paciente colocado en posición supina, con la cabeza fija en cabezal Sugita de 4 puntos, con una rotación de 15° hacia el lado contralateral. Una craneotomía pterional clásica con fresado del ala esfenoidal, con apertura de la fisura silviana y carotidea se realizaron bajo el microscopio. Se realiza una incisión dural circunferencial sobre el canal óptico. El techo óseo del canal óptico, así como sus paredes medial y lateral, se eliminan cuidadosamente con una fresa diamantada de 3mm con drill de alta velocidad con irrigación constante para evitar daños térmicos sobre el nervio óptico. El nervio óptico con un disector de Penfield N° 7 se eleva suavemente, lejos de la arteria carótida, para facilitar la exposición del cuello aneurismático para el clipado. Resultados: La apertura extensa del canal óptico y la vaina del nervio óptico se logró con éxito en el paciente, lo que permitió un ángulo de trabajo con la arteria carótida para la correcta visualización del aneurisma. Se logró el correcto clipado en el control de AngioCT postoperatoria. Conclusión: La foraminotomía óptica es una técnica fácil y recomendada para exponer y tratar aneurismas carotídeos-oftálmicos superiores y, además, permitir la descompresión del nervio óptico.

Introduction: Carotid-ophthalmic aneurysms usually cause visual problems, and its surgical treatment remains challenging due to the goal of preserving and/or improving the visual outcome. Case description: We present a surgical intervention of superior carotid-ophtalmic aneurysm. A 64-year-old man with a left inferior visual field deficit and headache. The angio CT reconstruction showed a left incidental superior carotid-ophthalmic aneurysm (4x5mm). Patient positioned in supine, with the head fixed in a 4 pin Sugita headholder with a 15° rotation to the contralateral side. A pterional craniotomy and flattening of sphenoid ridge with the usual drilling procedure with the opening of the Sylvian fissure to the carotid cistern were done under the microscope. A circumferential dural incision is made above the optic canal. The bony roof of the optic canal as well as its medial and lateral walls are carefully removed with a 3mm diamond high speed drill under constant irrigation to avoid thermal damage to the optic nerve. The optic nerve becomes gently retractable with a N° 7 Penfield dissector to some extent away from the carotid artery, to facilitate the aneurysmal neck exposure for clipping. Results: Extensive opening of the optic canal and optic nerve sheath was successfully achieved in the patient allowing a working angle with the carotid artery for correct visualization of the aneurysm. The correct clipping was observed in the postoperative AngioCT control. Conclusion: Optic foraminotomy is an easy and recommended technique for exposing and treating superior carotid-ophthalmic aneurysms and moreover allowing optic nerve decompression.

The efficacy of microsurgical clipping treatment for intracranial aneurysm rupture and optimal timing research / 中国基层医药

Objective@#To study the clinical efficacy of microsurgical clipping treatment for intracranial aneurysm rupture and optimal timing.@*Methods@#From January 2016 to December 2017, 80 patients with intracranial aneurysm rupture in Taizhou Enze Medical Center(Group) Hospital were randomly divided into the control group (24-72h after rupture) and the observation group (within 24h after rupture) according to the digital table, with 40 patients in each group.The pre- and intra-surgical re-rupture and surgical clipping, post-surgical complications, and clinical efficacy of 6-month follow-up in the two groups were observed and compared.@*Results@#Compared with the control group, the incidence rate of pre-surgical re-rupture was significantly reduced in the observation group (0.0% vs.10.0%, χ2=4.21, P<0.05). Compared with the control group, the incidence rate of post-surgical complications was obviously reduced in the observation group (20.0% vs.42.5%, χ2=4.71, P<0.05). Compared with the control group, the excellent rate of treatment was significantly improved in the observation group (87.5% vs.65.0%, χ2=5.59, P<0.05).@*Conclusion@#The microsurgical clipping treatment can improve the clinical efficacy of intracranial aneurysm rupture and sooner surgery with better prognosis.

Analysis of balloon-assisted occlusion technique in hybrid operation of paraclinoid aneurysms of internal carotid artery / 中国脑血管病杂志

Objective To evaluate the safety and effectiveness of balloon-assisted clipping of paraclinoid aneurysms with hybrid operatioa Methods From July 2011 to July 2018,119 consecutive patients treated with the balloon-assisted clipping of paraclinoid aneurysms at the Hybrid Operation Room, Department of Neurosurgery, West China Hospital,Sichuan University were enrolled retrospectively. Patients' age, gender, Hunt-Hess grade, ocular symptoms at admission, and location and size of aneurysms were collected. Balloon-assisted craniotomy for clipping aneurysms was used ,95 of them were treated with detachable balloon at the proximal end of the aneurysms, and 24 were blocked by balloons in the aneurysm neck straddles. During the operation,the state of discharge after surgery,and the follow-up results at 6 months after discharge of the patients were observed. The operation effect and complications were evaluated.Results Of the 119 patients,94 were female and 25 were male;aged 27 -82 years (mean 57 ± 15 years). Twenty-nine patients (24. 4%) showed decreased vision,62 (52. 1%) had dizziness and headache symptoms. The remaining 28 had no obvious symptoms. Hunt-Hess grade III in 3 cases (2. 5%) ,grade I-II in 42 cases (35. 3%) ,the remaining 74 (62. 2%) were unruptured aneurysms. Twenty-one patients (17.6%) had clinoid segment aneurysms, 82 (68.9%) had ophthalmic segment aneurysms, and 16 (13. 4%) had posterior communication aneurysms. The maximum diameter of the aneurysms was 5 to 35 mm (mean 19 ±7 mm) ,and the aneurysm diameter of 112 patients (94.1%) were > 10 mm. The aneurysms were successfully clipped in 111 cases (93. 3%) during the operation. Five patients had aneurysm neck and internal carotid artery lacerations during the clipping,and one was obviously unable to be clipped due to the neck calcification. After Hyperglide balloon saddle block, 1 patient occurred balloon rupture during the puncture and aspiration of the aneurysmal cavity. When the balloon was blocked in 1 case, balloon displacement occurred during repeated filling adjustment of aneurysm clips and the distal end detached into an aneurysm cavity and was clipped by an aneurysm clip. Three patients died at discharge, they were all aneurysm neck and internal carotid artery lacerations, and they were patients with massive cerebral infarction after aneurysm tapping. Five patients were in a coma; another 6 had hemiplegia symptoms. The remaining 105 patients (88. 2%) had no obvious neurological deficits at discharge. Six months after discharge, 11 patients with neurological deficits were followed up by telephone. Among the 5 comatose patients,3 died within one week after discharge. The consciousness of 2 cases changed from coma to indifference, their left limb muscle strength was grade III,and blurred vision was the same as before operation. Of the 6 hemiplegic patients, 1 died 3 months after discharge, and the other 5 had clear consciousness and their blurred vision was the same as before operation, all had limb hemiplegia, and their muscle strength was grade I - U - Conclusion Hybrid surgery with balloon-assisted clipping technique may effectively treat complex paraclinoid aneurysms.

Effect analysis of microsurgical clipping treatment of middle cerebral aneurysms / 中国脑血管病杂志

Objective To investigate the safety and effectiveness of microsurgical clipping for the treatment of middle cerebral artery aneurysms (MCAA). Methods From May 2008 to May 2018,the clinical and imaging data of 241 consecutive patients with MCAA (258 aneurysms) treated with microsurgical clipping at the Department of Neurosurgery,General Hospital of Eastern War Zone were analyzed retrospectively, including 160 patients ( 172 aneurysms) with ruptured aneurysm (ruptured group) and 81 patients (86aneurysms) with unruptured aneurysm (unruptured group). Aneurysm clipping or aneurysm clipping + hematoma evacuation was used via ptcrion approach. The Glasgow coma scale ( GCS) score was used to evaluate the state of consciousness before and after surgery in patients of the ruptured group. The clinical and imaging follow-ups (CT angiography [ CTA ] or DSA ) were performed regularly after procedure. SPSS 20. 0 statistical software was used to analyze and process the data. Results All the aneurysms were completely clipped during the operation in both groups. Of the 160patients in the ruptured group,the preoperative GCS score was 8 ±2,9 had cerebral infarction in the blood supply area of middle cerebral artery branches after operation,3 had hydrocephalus after operation, and 2 had unexplained cerebral hemorrhage after operation. The incidence of postoperative complications was 8. 8% ( 14/160). No aneurysm was found on CT angiography or DSA after procedure. Postoperative GCS score 9±3 at 15±2d was improved compared with the preoperative CCS score (< = -6. 240, P <0. 01). Seventy-eight patients were followed up without aneurysm recurrence. Of the 81 patients in the unruptured group,7 (8.6%) had cerebral infarction in the blood supply area of middle ccrcbral artery branches after operation. No aneurysms recurrence was found on CTA or DSA after operation, and 45 patients were followed up without aneurysm recurrence. There was no significant difference in the incidence of postoperative complications between the two groups (x∗ =3.280, 0. 194). Conclusion Microsurgery clipping is a safe and effective method for MCAA,and it is very important to improve the conscious state in patients with aneurysm rupture.

The efficacy of microsurgical clipping treatment for intracranial aneurysm rupture and optimal timing research / 中国基层医药

To study the clinical efficacy of microsurgical clipping treatment for intracranial aneurysm rupture and optimal timing.Methods From January 2016 to December 2017,80 patients with intracranial aneurysm rupture in Taizhou Enze Medical Center ( Group) Hospital were randomly divided into the control group (24-72h after rupture) and the observation group (within 24h after rupture) according to the digital table,with 40 patients in each group.The pre-and intra-surgical re-rupture and surgical clipping ,post-surgical complications, and clinical efficacy of 6-month follow-up in the two groups were observed and compared.Results Compared with the control group,the incidence rate of pre -surgical re-rupture was significantly reduced in the observation group (0.0%vs.10.0%,χ2 ＝4.21,P＜0.05).Compared with the control group ,the incidence rate of post -surgical complications was obviously reduced in the observation group (20.0%vs.42.5%,χ2 ＝4.71,P＜0.05).Compared with the control group ,the excellent rate of treatment was significantly improved in the observation group (87.5%vs. 65.0%,χ2 ＝5.59,P＜0.05).Conclusion The microsurgical clipping treatment can improve the clinical efficacy of intracranial aneurysm rupture and sooner surgery with better prognosis.

Application of microsurgical clipping and intravascular embolization in patients with intracranial aneurysm / 局解手术学杂志

Objective Our retrospective study was aimed to analyze the clinical significance of microsurgical clipping and intravascular embolization in patients with intracranial aneurysm (IA).Methods Clinical data of 86 patients with IA received treatment at our hospital from February 2010 to November 2014 was retrospectively analyzed.Patients were divided into two groups according to the treatment method, IE group (intravascular embolization,43 cases)and MC group (microsurgical clipping,43 cases).The general information,treatment effect, hospitalization expenses and time and the rate of complication of the patients between two groups were compared.Results There was no sta-tistical difference in general information between two groups (P >0.05).The cure rate of patients in IE group was obviously better than that in MC group (P <0.01).The hospitalization expenses in IE group was lower than that in MC group,and the hospitalization time was shorter than that in MC group,all the differences had statistical significance (P <0.01).The rate of complication in IE group was obviously lower than that in MC group (P <0.01).Conclusion The clinical effect of intravascular embolization was significantly better than microsurgical clipping,which is worth promoting in clinic.

Analysis of predictable factors of intra-operative aneurysm rupture of anterior circulation aneurysm treated by clipping / 中国综合临床

Objective To discuss the predictable factors for the occurrence of intra-operative aneurysm rupture(IAR).Methods A total of 84 patients with 101 aneurysms treated by neurosurgical clipping from September 2009 to September 2014 were retrospectively analyzed.The statistic analysis was performed for the risk factors of IAR such as aneurysm location,aneurysm sac,dome/neck ratio,direction,pre-operative Hunt-Hess Scale,history of hypertension and operation time.Results Eighteen cases (21.4％) occurred LAR (18 (17.8％) of aneurysms) during the operations,2 patients (2.4％) died.Statistic analysis revealed that preoperative Hunt-Hess scale (P =0.042),history of hypertension (P =0.038),aneurysm sac (P =0.012),dome/neck ratio(P=0.027),direction (P =0.010) and operation time (P =0.002) were the predictable factors for the occurrence of IAR,while the location of aneurysm was not included (P =0.199).Conclusion The IAR may be the result of the synthesis of various factors in the occurrence of intracranial aneurysms clipping.Hypertension history,Hunt-Hess scale,direction,aneurysm sac,operation time and dome/neck ratio 1.78-2.89 are the predictable factors for the occurrence of IAR and the combination of various factors leads to the occurrence of IAR.

Intraoperative aneurysm rupture of anterior circulation aneurysm treated by clipping:analysis of predictable factors / 中国医师进修杂志

Objective To discuss the predictable factors for the occurrence of intraoperative aneurysm rupture(IAR) of anterior circulation aneurysm treated by clipping.Methods The clinical data of 96 patients with 115 aneurysms treated by clipping were retrospectively analyzed.The univariate analysis and Logistic regression analysis was performed for the risk factors of IAR such as history of hypertension,pre-operative Hunt-Hess scale,aneurysm location,aneurysm sac,aneurysm dome/neck ratio,aneurysm direction,and operation time.Results Twenty-one patients occurred IAR [18.3 ％ (21/115) of aneurysms,21.9％ (21/96) of patients] during the operation,2 patients died and 94 patients were estimated by Rank scale:0 score was for 66 patients,2 scores was for 10 patients,3 scores was for 6 patients,4 scores was for 4 patients,5 scores was for 6 patients and 6 scores was for 2 patients at 6 months after surgery.Statistic analysis revealed that history of hypertension (P =0.037),pre-operative Hunt-Hess scale (P =0.040),aneurysm direction (P =0.009),aneurysm sac (P =0.010),operation time (P =0.001) and aneurysm dome/neck ratio (P =0.029) were the predictable factors for the occurrence of IAR,while aneurysm location was not included (P =0.198).Conclusion The history of hypertension,pre-operative Hunt-Hess scale,aneurysm direction,aneurysm sac,operation time and aneurysm dome/neck ratio 1.78-2.89 are the predictable factors for the occurrence of IAR and the combination of various factors lead to the occurrence of IAR.

Clinical Outcomes of Treatment for Intracranial Aneurysm in Elderly Patients

OBJECTIVE: The aim of this study is to evaluate the clinical course of intracranial aneurysm in patients aged 65 years and older and the immediate outcome after its aggressive management. MATERIALS AND METHODS: We performed a retrospective analysis using the medical records of 159 elderly patients managed at our institute from September 2008 to December 2013. Obtained clinical information included age, sex, Hunt and Hess grade (HHG), aneurysm location, Fisher grade (FG) and the treatment modality. Concomitant clinical data aside from cerebrovascular condition (hypertension, diabetes, previous medication) were evaluated to determine risk factors that might affect the functional outcomes. RESULTS: A total of 108 patients (67.9%) presented with subarachnoid hemorrhage (SAH), and 51 (32.1%) with unruptured intracranial aneurysms (UIAs). Coiling was performed in 101 patients and 58 patients underwent clipping. In the SAH population, 62 patients (57.4%) showed favorable outcomes, with a mortality rate of 11.3% (n = 18). In the UIAs population, 50 (98%) patients achieved 'excellent' and one (2%) achieved 'good' outcome. Factors including high-grade HHG (p < 0.001), advanced age (p = 0.014), and the presence of intraventricular hematoma (IVH) (p = 0.017) were significant predictors of poor outcome. CONCLUSION: SAH patients with high grade HHG and IVH are associated with poor outcome with statistical significance, all the more prominent the older the patient is. Therefore, the indication for aggressive therapy should be considered more carefully in these patients. However, as the outcomes for elderly patients with UIAs were excellent regardless of the treatment modality, aggressive treatment could always be considered in UIAs cases.

Clinical Outcome of Paraclinoid Internal Carotid Artery Aneurysms After Microsurgical Neck Clipping in Comparison with Endovascular Embolization

OBJECTIVE: Because of the complex anatomical association among vascular, dural, and bony structures, paraclinoid internal carotid artery (ICA) aneurysms remain a major challenge for vascular neurosurgeons. We studied the clinical outcomes of 61 paraclinoid ICA aneurysms after microsurgical clipping in comparison with endovascular coiling. MATERIALS AND METHODS: Between January 2008 and December 2012, we treated 61 paraclinoid ICA aneurysms created by surgical clipping or endovascular coiling. Preoperative neurologic status and postoperative outcome were evaluated using the Glasgow coma scale (GCS) and the modified Rankin scale (mRS). Postoperative hydrocephalus and vasospasm were reviewed using the patients' medical charts. RESULTS: Most patients were in good clinical condition before the operations and had good treatment outcomes. Clinical vasospasm was observed after the operation in five patients, and hydrocephalus occurred in six patients. No statistically significant difference regarding aneurysm size, sex, GCS score, H-H grade, and mRS was observed between the surgical clipping group and the endovascular coiling group. In addition, the treatment results and complications did not show statistically significant difference in either group. CONCLUSION: Surgical occlusion of paraclinoid ICA aneurysms is difficult; however, no significant differences were observed in the treatment results or complications when compared with coil embolization. In particular, use of an adequate surgical technique may lead to better outcomes than those for coil embolization in the treatment of large and/or wide-neck paraclinoid ICA aneurysms.

Internal Carotid Artery Reconstruction Using Multiple Fenestrated Clips for Complete Occlusion of Large Paraclinoid Aneurysms

OBJECTIVE: Although surgical techniques for clipping paraclinoid aneurysms have evolved significantly in recent times, direct microsurgical clipping of large and giant paraclinoid aneurysms remains a formidable surgical challenge. We review here our surgical experiences in direct surgical clipping of large and giant paraclinoid aneurysms, especially in dealing with anterior clinoidectomy, distal dural ring resection, optic canal unroofing, clipping techniques, and surgical complications. METHODS: Between September 2001 and February 2012, we directly obliterated ten large and giant paraclinoid aneurysms. In all cases, tailored orbito-zygomatic craniotomies with extradural and/or intradural clinoidectomy were performed. The efficacy of surgical clipping was evaluated with postoperative digital subtraction angiography and computed tomographic angiography. RESULTS: Of the ten cases reported, five each were of ruptured and unruptured aneurysms. Five aneurysms occurred in the carotid cave, two in the superior hypophyseal artery, two in the intracavernous, and one in the posterior wall. The mean diameter of the aneurysms sac was 18.8 mm in the greatest dimension. All large and giant paraclinoid aneurysms were obliterated with direct neck clipping without bypass. With the exception of the one intracavenous aneurysm, all large and giant paraclinoid aneurysms were occluded completely. CONCLUSION: The key features of successful surgical clipping of large and giant paraclinoid aneurysms include enhancing exposure of proximal neck of aneurysms, establishing proximal control, and completely obliterating aneurysms with minimal manipulation of the optic nerve. Our results suggest that internal carotid artery reconstruction using multiple fenestrated clips without bypass may potentially achieve complete occlusion of large paraclinoid aneurysms.

Functional Outcome of Microsurgical Clipping Compared to Endovascular Coiling

Endovascular coiling has been used increasingly as an alternative to neurosurgical clipping for treating subarachnoid hemorrhage secondary to aneurysm rupture. In a retrospective cohort review on the treatment methods of aneurysm rupture in Hospital Kuala Lumpur over the period of five years (2005-2009) a total of 268 patients were treated. These patients were broadly categorized into two groups based on their treatment mode for ruptured aneurysms. Statistical analysis was determined using Chi- Square tests to study these associations. In our study, 67.5% of patients presented with Good World Federation of Neurosurgical Societies (WFNS) grade (WFNS1-2) while 32.5% patients presented with Poor WFNS prior to intervention. In our outcome, it was noted that 60.4% had good functional outcome (mRS grade 0-2) as compared to 39.6% patients who had poor mRS(modified rankin scale) outcome (mRS 3-6). In the good WFNS group, 76% of patients in clipping group had a good mRS outcome while, 86.5% patients in coiling group had good mRS outcome (p=0.114). In poor WFNS presentation, it was noted that in 77.3% patients in clipping group, had poor mRS outcome. Similarly with poor WFNS presentation, 83.3% of patient in coiling group had poor outcome. (p=1.00). Hence when we control the WFNS group, there was no significant association between treatment group (clipping and coiling) and mRS outcome at 6 months. The outcome of patient is determined by initial clinical presentation (WFNS grade) and influenced by requirement of Extraventricular drain (EVD) in presence of hydrocephalus, CSF infection and pneumonia. Therefore the decision regarding treatment option needs to be individualized based on the presentation of the patient.

The Comparative Study of Microsurgical Cerebral Aneurysm Clip Implants; Titanium Clip vs. Stainless Steel Clip

OBJECTIVE: To perform a comparative study between two groups of populations, titanium (T) group versus stainless steel (S) group, who were clipped with titanium and stainless steel materials, respectively, the incidence of regrowth from the original aneurysms, the clip slippage, and post-clipping seizure attack were analyzed. The patients were followed more than 5 years after microsurgical cerebral aneurysms clipping. METHODS: Data from 1986 through 2008 were extensively reviewed on a consecutive series of 3,770 patients who referred for ruptured/unruptured cerebral aneurysms. Forty-seven patients in the S group and 48 in the T group who met inclusion criteria, were selected for this study. RESULTS: The incidence of regrowth were noted that two out of total 47 patients (4.3%) in the S group, and none in the T group. The clip slippage was not observed in both groups. And there was no statistical difference (p = 0.242) in terms of regrowth between two groups. Seven out of 47 cases (14.9%) developed post-clipping seizure in the S group. On the other hand, two (4.2%) of 48 patients presented the symptom in the T group. Also, there was no significant difference (p = 0.091) between two groups. CONCLUSIONS: The metallic types of clip employed for the microsurgical cerebral aneurysm clipping does not have any significant clinical outcome differences in this study.

Research of the safety of multi-slice computer tomography angiography as the evaluative criteria before aneurismal microsurgical clipping / 中华急诊医学杂志

Objective To evaluate if MS-CTA can be the primary and sole evaluative criteria for the treatment of intracranial aneurysms by microsurgery clipping. Methods Between January 2008 and October 2010, 105 patients with intracranial aneurysm underwent microsurgery clipping in our institution were respectively analyzed, out of which 39 patients with preoperative MS-CTA (64- or 320-slice CT scanner) examinations (MS-CTA group) , 21 with MS-CTA combined with DSA and 45 with DSA ( DSA group). The aneurismal size, neck, morphous and peripheral branches were compared between the CTA data and operative results, and the concordance between which were analyzed. The rate of operative complication and the GOS scale at discharge were also compared between MS-CTA group and DSA group. t test, Chi-Square test or Rank test were used for analysis of the patients' baseline data, Kappa test for the concordance between MS-CTA and operative results, Kruskal-Wallis test for operative complication and Mann-whitney test for the GOS at discharge between MS-CTA group and DSA group. Results Thirty-seven patients out of the MS -CTA group obtained successful microsurgery clipping, with 1 transferred to coil embolization because of the difficulty in exposing the aneurismal neck and 1 to decompressive craniectomy because of aneurismal rebleeding at removal cranium. There was a good concordance between MS-CTA and operative results on depicting aneurysmal size and neck ( κ =0.726 ,κ =0. 756) and a ordinary concordance on morphous and peripheral branches ( κ =0.524, κ =0.473). There was no significant difference on the rate of operative complication (P =0.509) and GOS scale (P =0.239) at discharge. Conclusions MS-CTA can reveal the important characteristics of intracranial aneurysms, and has a high safety as being the primary and sole criteria before microsurgery clipping.

A Comparative Study of Microsurgical Clipping and Endovascular Coiling in the Treatment of Ruptured Cerebral Aneurysms / 대한뇌혈관외과학회지

OBJECTIVE: Recently the treatment of endovascular coil embolization is gradually increasing compared to the traditional method of microsurgical clipping. However, both methods carry certain risks. The aim of this study was to compare each method's morbidity and complications in patients with ruptured cerebral aneurysms. METHODS: We investigated patients who underwent surgery for subarachnoid hemorrhage (SAH) due to cerebral aneurysm rupture between January 2007 to December 2009 in our hospital. Patients' medical records and radiologic images were referenced and initial grade, location and size of aneurysm, treatment method, complications, prognosis, hospital stay and the cost were retrospectively investigated. We divided the patients into two groups according to surgical METHODS: clipping group and coiling group. Treatment results were evaluated using Modified Rankin Scale (MRS). RESULTS: Total 187 aneurysms were treated in 149 patients. Sixty-five and 84 patients were classified as clipping group and coiling group, respectively. The ratio of patients with good outcome in clipping vs. coiling was 83.6% vs. 80.8%. The incidence of vasospasm was significantly lower in the coiling group compared to the clipping group. The length of hospitalization was shorter in the coiling group. The cost and operation time was also less in the coiling group. However, higher numbers of remnant sac and coil compaction were observed in the coiling group. CONCLUSION: Endovascular coil embolization for ruptured cerebral aneurysms had fewer vasospasms and complications. Also, it reduced the hospital stay, operation time, and cost compared with the clipping group. So, in addition to traditional microsurgical neck clipping, we think that endovascular coiling is a good alternative method to treat ruptured aneurysms.

Treatment of the Posterior Circulation Aneurysms / 대한뇌혈관외과학회지

OBJECTIVE: Endovascular treatment is now accepted as an initial treatment modality, especially in cases of posterior circulation aneurysms. The purpose of this study was to review the treatment outcomes and to emphasize the necessity of maintaining the surgical ability for posterior circulation aneurysms. METHODS: During the past 10 years, 570 patients have been treated for cerebral aneurysms at our institute. Among these patients, 34 harbored posterior circulation aneurysms. From January 2004 to June 2008, 13 of the 34 patients were treated by endovascular coiling. We retrospectively reviewed the clinical outcome, cerebral angiograms, and other radiological imagings through a comparative study of the pre- and post-endovascular treatment periods. RESULTS: Overall, 9 (69.2%) of the pre-endovascular treatment period group and 20 (95.2%) of the endovascular treatment period group had good outcomes. The mean post-operative hospital days for these groups were 38.6 and 21.1, respectively. Patients in the endovascular treatment period group had shorter post-operative hospital periods and better outcomes than those in the pre-endovascular treatment period group. CONCLUSION: It is recommended that multimodality treatment involving microsurgical clipping and endovascular coiling is used to obtain better results in the treatment of posterior circulation aneurysms. These results suggest that although the trend toward endovascular treatment as the initial aneurysm therapy for posterior circulation aneurysms is also enhancing, it might be necessary to maintain the surgical ability for posterior circulation aneurysm.

A clinical study that microsurgical clipping combined endovascular embolization therapy of intracranial aneurysm / 中华显微外科杂志

Objective To analyzed the treatment of intracranial aneurysms by mierosurgical clipping, endovascular embolization and embolization combined clipping therapy.In order to explore the ideal and effec- tive treatment plan of intracranial ruptured aneurysm.Methods The clipped group of 30 aneurysms.The embolized group of 34 aneurysms.The combined group of 15 aneurysms.Results Clipped group:All of aneurysms was clipped well,no recurrence,mortality 6%(2/30).Embolized Group:complete embolization rate 70.6%(24/34),recurrence rate 17.6%(6/34),mortality 11.8%(4/34).Combined group:no recur- rence,mortality 6.7%(1/15).All patients of three groups were evaluated by Glasgow Outcome Scale one month later and the rate of recovery well was 80.0%,79.4%and 80.0%.Following up for six months the data were 90.0%,88.2%and 86.7%.Conclusion Microsurgical clipping aneurysm(?)neck is still an ef- fective therapy.Meanwhile it has an absolute advantage of high completely cure rate and low recurrence rate, furthermore it is an available remediation method for those cases that failure of embolization,and for those re- currence aneurysms that have been embolized,microsurgical clipping should be,taken as soon as possible in case of aneurysms re-ruptured.For the patients the aneurysms are narrow shape,irregular shape,small(≤3 nun)or with cerebral hematomas microsurgical clipping is a fitting choice.