Individualized microsurgical treatment of intracranial anterior circulation giant aneurysms: A report of 22 cases / 第二军医大学学报

ABSTRACT

Objective To investigate the individualized microsurgical treatment regimens for intracranial anterior circulation giant aneurysms and to assess their effectiveness. Methods We retrospectively analyzed the clinical data of 22 patients with anterior circulation giant aneurysms who were treated with microsurgery from May 2006 to May 2016. There were 9 ruptured aneurysms and 13 unruptured aneurysms. The surgical methods included direct clipping of the aneurysmal neck in 5 cases, thrombectomy-aneurysm clip reconstruction in 12 cases, aneurysm excision combined with vessels reconstruction in 2 cases, trapping of the aneurysm in 2 cases, and cervical internal carotid artery ligation in 1 case. Prognoses of patients were evaluated by Glasgow Outcome Scale (GOS). Results At discharge, 14 of the 22 patients recovered well and regained normal life (GOS 5), 5 patients had mild disability (GOS 4), 2 had severe disability (GOS 3), and one died (GOS 1). The mean follow-up time was (39±30) months (ranging from 3 to 118 months). Post-operative three-dimensional CT angiography (3D-CTA) or three-dimensional digital subtraction angiography (3D-DSA) showed that complete angiographic obliteration was achieved in all the 21 survivors; there were 17 survivors with GOS 5, 2 with GOS 4, 1 with GOS 3, and 1 with GOS 1. The mortality and morbidity of patients were 9. 1% (2/22) and 13. 6% (3/22), respectively. Analysis of factors influencing of prognosis showed that there was no significant difference in patients outcomes between groups of age (P=1. 324), sex (P=2. 346), aneurysm size (P=0. 856), Hunt-Hess grade (P=0. 196), or aneurysmal rupture (P=0. 172), and there was significant difference in patients outcomes between microvascular Doppler (MVD) group and none MVD group (P=0. 036). Conclusion Detailed pre-operative evaluation and individualized surgical plan are necessary for patients with intracranial anterior circulation giant aneurysms. Surgeon’s microsurgical experiences and skills together with intra-operative monitoring is the guarantee for satisfactory effectiveness of microsurgery treatment.