ABSTRACT
Objective To investigate the effectiveness and safety of endovascular coiling and microsurgical clipping for ruptured intracranial aneurysms. Methods Patients w ith ruptured intracranial aneurysm treated w ith endovascular coiling or microsurgical clipping w ere enrol ed retrospectively. The demography, baseline clinical data, outcome, and complications in patients received endovascular coiling and microsurgical clipping w ere compared. Results A total of 85 patients w ith ruptured intracranial aneurysm were enroled, including 40 were treated with microsurgical clipping (surgical clipping group) and 45 were treated w ith endovascular coiling (endovascular coiling group). There w ere no significant differences in the proportions of the patients in male (37.5%vs.40.0%; χ2 =0.056, P=0.813), hypertension (30.0%vs. 33.3%; χ2 =0.109, P=0.742 ), smoking ( 50.0%vs.48.9%; χ2 =0.010, P=0.918 ), drinking (45.0%vs.46.7%; χ2 =0.024, P=0.878), aneurysm site (anterior communicating artery: 50.0%vs. 48.9%;posterior communicating artery:35.0%vs.33.3%; middle cerebral artery:10.0 %vs.11.1%;vertebral artery: 5.0%vs.6.7%; al P>0.05), aneurysm maximum diameter < 10 mm (80.0%vs. 77.8%;χ2 =0.063, P=0.802), Hunt-Hess grade 1-2 (55.0%vs.57.8%; χ2 =0.066, P=0.797), Fisher grade 1-2 ( 60.0%vs.57.8%; χ2 =0.043, P=0.835 ), and time from onset to treatment < 72 h (62.5%vs.64.4%; χ2 =0.035, P=0.853) in the surgical clipping group and endovascular coiling group. There w ere no significant differences in the complete occlusion rate of aneurysms ( 97.5%vs.91.1%;P=0.364) and the good outcome rate (65.0%vs.68.9%; χ2 =0.145, P=0.703) betw een the surgical clipping group and the endovascular coiling group. No patients died in the surgical clipping group and 1 patient died in the endovascular coiling group, and there w as no significant difference ( P=1.000). One patient (2.5%) had cerebral infarction in the surgical clipping group and no patients had cerebral infarction in the endovascular coiling group, and there w as no significant difference ( P=0.471). Conclusions The efficacy and safety of microsurgical clipping are the same as those of endovascular coiling for ruptured intracranial aneurysms.
ABSTRACT
Objective To compare the efficacy, complications, safety and prognosis of the minimally invasive puncture approach and key hole in the treatment of hypertensive cerebral hematoma.Methods A totol of 68 patients with hypertensive cerebral hematoma confirmed by CT from April 2012 to October 2013 in Nongken Sanya Hospital were randomly divided into key hole evacuation group(n=32) and minimally invasive puncture group (n =36).Comparisons were made between the two surgical methods in the operative time, postoperative complications, the fatality and the postoperative re-haemorrhagia rate, neurological function deficit score also been observed and evaluated in the 1 st,2nd and 4th weeks after surgery.Results The NFDS scores of the two groups both decreased in the 1st week after surgery,but compare with preoperative the difference was not statistically significant (P ＞ 0.05).In the 2nd weeks and 4th weeks after surgery, NFDS scores further decreased in both group,and there was statistically significant compare with preoperative(the key hole evacuation group : (26.2±4.5) vs.(17.8 ± 3.6) vs.(44.1 ± 5.4) scores;the minimally invasive puncture group: (22.1 ± ±3.7) vs.(15.4±2.8) vs.(43.9±6.2)scores;P＜0.05) ,but during the same period there was no significant difference between the two groups with NFDS scores(P＞0.05).The rebleeding rate of the minimally invasive puncture group was significantly lower than the key hole evacuation group (4.08％ vs.16.33％, x2=6.56, P＜0.05).There was no significant difference in mortality rate and long term total effect between two groups (P＞0.05).Conclusion Although both key hole and minimally invasive puncture are effective measures for treatment of hypertensive cerebral hemorrhage, but minimally invasive puncture with less trauma, definite curative effect and higher security advantages in clinical.