Comparación del tratamiento quirúrgico y endovascular de aneurismas del segmento comunicante posterior / Comparison of surgical and endovascular treatment of posterior communicating segment aneurysms

RESUMEN

Introducción: Los aneurismas del segmento comunicante posterior representan aproximadamente 25% de todos los aneurismas intracraneales, y el 50% de los aneurismas de la arteria carótida interna. El objetivo fue evaluar la eficacia del tratamiento quirúrgico y endovascular en el manejo de aneurismas de esta localización. Material y Métodos: Estudio comparativo retrospectivo. Se revisó las historias clínicas de pacientes con aneurisma del segmento comunicante posterior que ingresaron al departamento de Neurocirugía del Hospital Nacional Guillermo Almenara durante el periodo 2010-2017. Se comparó estancia hospitalaria, complicaciones, mortalidad y estado funcional a los 12 meses, en relación al tratamiento recibido, microquirúrgico o endovascular. Resultados: Se evaluaron 256 pacientes, 111 (43,36%) recibieron tratamiento quirúrgico, y 145 (56,64%) endovascular. En el caso de aneurismas rotos, el estado de independencia funcional fue alcanzado por 68 (66,7%) y 69 (70,4%) pacientes que recibieron tratamiento quirúrgico y endovascular, respectivamente (OR0.84, IC 95% 0.46­1.53; p=0.505). Se presentaron complicaciones neurológicas en 37 (36,3%) y 34 (34.7%) pacientes sometidos a tratamiento microquirúrgico y endovascular, respectivamente (OR 1.07, IC 95% 0.60­1.91; p=0.912). La estancia hospitalaria promedio fue 19,55±13.85 y 14.06±14.97 días, para pacientes con tratamiento quirúrgico y endovascular, respectivamente (p<0.008). La mortalidad fue 11,8% y 11,2%, con ligera predominancia en el grupo tratado quirúrgicamente (OR 1.05, IC 95% 0.44­2.52; p=0.904). Conclusiones: No existe diferencia significativa respecto al resultado funcional a los 12 meses, complicaciones y mortalidad entre ambos tipos de tratamiento en el caso de aneurismas rotos. Los pacientes sometidos a terapia endovascular tuvieron de forma significativa menor estancia hospitalaria

ABSTRACT

Background: Posterior communicating segment aneurysms represent about the 25% of all intracranial aneurysms and the 50% of the internal carotid artery aneurysms. The objective of the study was to evaluate the efficacy of the surgical and endovascular treatments in the management of the aneurysms of this localization. Methods: Comparative and retrospective study. Clinical charts of patients with aneurysms of the posterior communicating segment were reviewed during the period from 2010 to 2017 in the Guillermo Almenara Hospital. Hospital stay, complications, mortality and functional status at 12 months were compared among endovascular and surgical treatment. Results: Two hundred and fifty-six patients were evaluated, 111 (43,36%) were treated with surgery and 145 (54,64%) with endovascular therapy. Among ruptured aneurysms, functional independence status was reached in 68 (66,7%) and 69 (70,4%) of the patients who were treated with surgery and embolization respectively (OR0.84, IC 95% 0.46­1.53; p=0.505). Neurological complications were found in 37 (36,3%) and 34 (34,7%) patients treated with surgery and embolization respectively (OR 1.07, IC 95% 0.60­1.91; p=0.912). The mean hospital stay was 19,55±13.85 and 14.06±14.97 days of the patients treated with surgery and embolization respectively. Mortality was 11,8% and 11,2%, with a slight predominance in the surgically treated group (OR 1.05, IC 95% 0.44­2.52; p=0.904). Conclusions: There is no significant difference according to functional status at 12 months, complications and mortality among both type of treatments in the group of ruptured aneurysms. Patients treated with endovascular therapy had lower hospital stay with statistical difference