Journal of Korean Neurosurgical Society

  • 제59권3호
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  • Pages.269-275
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  • 2016
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Aneurysmal Neck Clipping as the Primary Treatment Option for Both Ruptured and Unruptured Middle Cerebral Artery Aneurysms

  • Choi, Jai Ho (Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine) ;
  • Park, Jung Eon (Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Myeong Jin (Department of Neurosurgery, Gachon University Gil Medical Center) ;
  • Kim, Bum Su (Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Shin, Yong Sam (Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • 투고 : 2015.06.13
  • 심사 : 2016.02.13
  • 발행 : 2016.05.01
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초록

Objective : Although middle cerebral artery (MCA) aneurysms are less amenable to coil embolization, an increasing number of studies support favorable endovascular treatment for them. The purpose of this study is to compare the outcomes of two different treatments (surgery versus coiling) and evaluate the benefits of surgical clipping for MCA aneurysms. Methods : Here we retrospectively analyzed the outcomes of 178 ruptured and unruptured MCA aneurysms treated in patients between September 2008 and April 2012. Parameters assessing treatment outcomes include degree of aneurysm occlusion, presence of regrowth, clinical status, and complications. Results : Among 178 MCA aneurysms, 153 were treated surgically. After a mean follow-up of 12 months, the surgery group showed a clinically significant complete occlusion rate (98%) compared with the coiling group (56%) (p<0.001). Follow-up radiologic evaluation showed a higher regrowth rate (four of 16 cases) in the coiling group than in the surgery group (one of 49 cases) (p=0.003). There was no statistically significant difference in favorable clinical outcome rate between the two groups. The procedure-related permanent morbidity and mortality rates were 2% (three of 153 cases) in the surgery group and 0% (0 of 25 cases) in the coiling group. Conclusion : Compared to endovascular treatment, surgical neck clipping for both ruptured and unruptured MCA aneurysms results in a significantly higher complete obliteration rate and less regrowth. Therefore, even in this endovascular era, we still recommend surgical clipping as the primary treatment option for MCA aneurysms rather than coil embolization.

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참고문헌

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피인용 문헌

  1. Does Neurosurgical Clipping or Endovascular Coiling Lead to More Cases of Delayed Hydrocephalus in Patients with Subarachnoid Hemorrhage? vol.20, pp.2, 2016, https://doi.org/10.7461/jcen.2018.20.2.87
  2. Procedural Clinical Complications, Case-Fatality Risks, and Risk Factors in Endovascular and Neurosurgical Treatment of Unruptured Intracranial Aneurysms : A Systematic Review and Meta-analysis vol.76, pp.3, 2019, https://doi.org/10.1001/jamaneurol.2018.4165
  3. Keyhole strategy aiming at minimizing hospital stay for surgical clipping of unruptured middle cerebral artery aneurysms vol.130, pp.4, 2019, https://doi.org/10.3171/2017.10.jns171973
  4. Keyhole strategy aiming at minimizing hospital stay for surgical clipping of unruptured middle cerebral artery aneurysms vol.130, pp.4, 2019, https://doi.org/10.3171/2017.10.jns171973
  5. Feasibility and efficacy of coil embolization for middle cerebral artery aneurysms vol.36, pp.3, 2016, https://doi.org/10.12701/yujm.2019.00192