A Single-center Comparative Analysis Of The Effects Of Intracranial Craniotomy And Endovascular Treatment On Middle Cerebral Artery Aneurysms

Background: Middle cerebral artery aneurysm(MCAA)is a common intracranial aneurysm with a high incidence.Microsurgical clipping is still the first choice for the treatment of MCAA.With the development of interventional techniques,endovascular coiling is a safe and effective treatment for MCAA.However,due to the lack of large sample randomized studies,MCAA treatment is still controversial.This study was designed to provide a clinical reference for the treatment of MCAA.Objective: By reviewing the curative effect of patients with cerebral arterial aneurysm microsurgical clipping and endovascular treatment in our hospital,we discussed the different characteristics of the two methods for the treatment of middle cerebral artery aneurysms.Methods: The clinical data of patients with middle cerebral artery aneurysms admitted to the Department of Neurosurgery,Affiliated Hospital of Qingdao University from January 2015 to December 2016 were retrospectively reviewed.The preoperative conditions,occurrence of intra-operative and postoperative adverse events,clinical results and follow-up results in the two treatment methods were analyzed statistically.Results: A total of 83 patients with middle cerebral artery aneurysms were included in the Hunt-Hess grade 3 and below.Among them,54 patients underwent microsurgical clipping and 29 underwent endovascular treatment.There was no statistically significant difference in preoperative data.The rate of non-advanced clinical discharge(m RS>3)was 13.0% in the microsurgical clipping cohort and 3.4% in the endovascular coiling cohort;the incidence of surgically-related adverse events was 31.5% in the microsurgical clipping cohort and 10.3% in the endovascular coiling cohort.The P value was less than 0.05.There was a statistical difference.The half-year follow-up had a poorer prognosis.The rate of endovascular coiling cohort(5.6%)was higher than that of the endovascular coiling cohort.The recurrence rate of the microsurgical clipping cohort was lower(1.9%)than that of the endovascular coiling cohort(6.9%);comparison of hospital length and ospitalization costs are statistically significant(P values<0.05).Conclusion: There is no significant difference in clinical evaluation and half-year follow-up evaluation of aneurysm discharge in patients with middle cerebral artery aneurysm after microsurgical clipping and endovascular coiling,but craniotomy has a higher rate of prognosis.Microsurgical clipping has more intra-operative and postoperative adverse events and long hospital stays,while endovascular coiling may cost more hospitalization costs.Microsurgical clipping is still the main treatment method for MCAA treatment,but endovascular coiling is also a safe and effective treatment,and it has a good prospect for development.Large sample random tests are still needed to further verify.