Abstract
Relevance: Until recently, microsurgical clipping was the main method to eliminate cerebral aneurysms (CA) from the circulation. The rate of endovascular versus microsurgical treatment for CA of different locations in the era of rapidly emerging endovascular medicine is unknown. Aim: To study the frequency of microsurgical or endovascular techniques for the treatment of CA of different locations. Methods: Methods of treatment and localization of CA were studied in meta-analysis of clinical series published from 2003 to 2014. Case-control studies, studies with externally balanced number of patients in the groups, and the series in which a large number of patients were treated out the study were excluded. Results: 1 international, 2 American, 2 Japanese and 3 Russian clinical series (n=5254 CA) were included in the meta-analysis. The pooled rate of microsurgical treatment used for the CA of the internal carotid artery was 65% (95% CI 55−75), the anterior cerebral artery ― 65% (95% CI 46−84), the middle cerebral artery ― 90% (95% CI 82−98), and vertebrobasilar basin ― 39% (95% CI 41−64). Conclusions: In clinical series both methods of CA treatment were available but endovascular closure was used for the majority of vertebrobasilar basin aneurysms, and for more than a third of anterior cerebral artery or internal carotid artery aneurysms. Middle cerebral artery aneurysms, as opposed to CA of other locations, were subjected to microsurgical treatment in the most cases (90%). In some cases CA are not suitable for endovascular closure, or require microvascular reconstructive operations. In competition with less invasive but more expensive option of endovascular treatment, and under the conditions of decreasing volume and experience of open CA surgery, microsurgical techniques should be mastered to a high level which requires centralization of the patients in the specialized centers and microneurosurgical training.
Highlights
46−84), средней мозговой артерии ― 90% (95% ДИ 82−98), вертебробазилярного бассейна ― 39% (95% ДИ 41−64)
Methods of treatment and localization of cerebral aneurysms (CA) were studied in meta-analysis of clinical series published from 2003 to 2014
Case-control studies, studies with externally balanced number of patients in the groups, and the series in which a large number of patients were treated out the study were excluded
Summary
Проанализированы опубликованные с 2003 по 2014 г. на наличие релевантных исследований. Для оценки выбора способа лечения ЦА при раз- включают в себя 5254 случая ЦА различной локализации. 2000 г., равен 14 случаям на 100 000 населения в год: до САК в течение первых двух недель составляет 25–30%, настоящего времени цитируется и признается отвечаю- является наиболее высокой в промежутке между первыми щим действительности. Если после САК в течение лей Ханты-Мансийского автономного округа в возрасте двух месяцев не произошло повторного кровоизлияния, 20 лет и старше, составила 27,3 (18,1–38,3) на 100 000 то риск последующего САК приравнивается к таковому у жителей в год, из которых 50% приходится на САК [14]. При этом проблемы лечения пациентов с цереброваскулярными зааневризматическое САК, как правило, происходит у лиц болеваниями развернута сеть нейрососудистых центров, трудоспособного возраста (40–50 лет), что обусловли- в которых концентрация пациентов неизбежно приводит вает высокую социально-экономическую значимость к накоплению опыта, организуются лаборатории и курсы проблемы. ПМА ― передняя мозговая артерия, ПСА ― передняя соединительная артерия, ВСА ― внутренняя сонная артерия, ЗСА ― задняя соединительная артерия, СМА ― средняя мозговая артерия, ВББ ― вертебробазилярный бассейн
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