| Background:Peripheral intracranial aneurysms(PIA)refer to the aneurysms far from the Willis Circle.The incidence rate is low,accounting for 1%~9% of intracranial aneurysms(IA).There are two conventional surgical methods for PIA: surgical clipping surgery and minimally invasive interventional surgery.Currently,there are different opinions on these two surgical methods.The technical difficulties of surgical clipping lie in the deep location of the aneurysm,small part of the capsule but wide or fusiform neck,narrow field of vision during surgery,limited operating space,and sometimes difficult to preserve the parent artery.Compared with craniotomy and clipping surgery,interventional embolization is less invasive,with less intraoperative bleeding,shorter operation time,and a wider range of surgical indications.Foreign studies have shown that the recurrence rate of aneurysms after interventional embolization is slightly higher than that after craniotomy,but there is no statistically significant difference between the two.Currently,there is no accurate conclusion as to which surgical treatment is the best for IA.The Systemic Immune Inflammation Index(SII)responds well to the severity of inflammation and immune status of patients,and has predictive value in both cancerous and non cancerous conditions.It has been increasingly proven to be useful in predicting the related prognosis of cerebrovascular diseases.However,there are few relevant studies on whether it can predict subarachnoid hemorrhage(SAH).This article discusses the therapeutic effects of intracranial aneurysm clipping and interventional surgery,and analyzes the predictive value of SII for the prognosis of patients with aneurysmal subarachnoid hemorrhage(a SAH).Objective:To compare the safety and prognosis of craniotomy and minimally invasive interventional surgery in the treatment of PIA,and to analyze the predictive value of SII for the prognosis of patients with a SAH.Methods:The clinical data of 92 patients with PIA admitted to the Department of Neurosurgery,Bethune First Hospital,Jilin University from April 2019 to November2022 were retrospectively analyzed.According to whether the PIA is ruptured or not,there are 65 patients in the ruptured group and 27 patients in the non ruptured group;According to the different surgical methods,26 patients were divided into the craniotomy clipping surgery group(hereinafter referred to as the clipping group)and the minimally invasive interventional surgery group(hereinafter referred to as the interventional group),with 66 patients(including 1 case of dense mesh stent,25 cases of coil embolization,35 cases of stent assisted coil embolization,and 5 cases of aneurysm and parent artery occlusion using onyx glue).Summarize the general information,surgical methods,complications,and prognosis of the above patients,and study and compare the safety and prognosis of PIA treatment in the clamp group and the interventional group.At the same time,the SII and prognosis of 65 SAH patients at 6 months after discharge were collated.The SII can be counted with neutrophils(× 109/L)× Platelet cell count(× 109/L)/lymphocyte count(×109/L).The modified Rankin scale(m RS)was used to evaluate the prognosis of patients,and the patients were divided into two groups.One group was a low m RS group(<3),indicating a good prognosis;One group was a high m RS group(≥ 3),indicating a poor prognosis.The receiver operating characteristic(ROC)curve was used to evaluate the ability of SII to predict the prognosis of patients and determine the optimal cutoff point.Results:There was no significant difference in general data between the clamp group and the interventional group(P>0.05),which was comparable.In the clamp group,there were 26 cases,15 cases with anterior circulation and 11 cases with posterior circulation;There were 66 cases in the intervention group,including 32 cases of anterior circulation and 34 cases of posterior circulation.The difference was not statistically significant(P>0.05).The success rate of surgery in both groups was 100%,and no aneurysm rupture occurred during surgery.In the intervention group,7 patients developed complications,accounting for 10.61% of the patients in the intervention group.In the clamping group,a total of 10 patients developed complications,accounting for 38.46% of the patients in the clamping group,with a statistically significant difference(P<0.05).Among the 7 complications,2 cases had vasospasm,which was treated with nimotop during and after surgery.After improvement,they were discharged from the hospital;Two patients presented with hydrocephalus symptoms: one patient had postoperative hydrocephalus and underwent outdoor drainage.Later,due to swelling of the brain tissue in the posterior cranial fossa,bone flap decompression was performed.The other patient presented with hydrocephalus symptoms after discharge and underwent outdoor drainage in a local hospital;One patient developed right side epistaxis,which improved after hemostasis with expanded sponge.In the clamp group,4 patients had speech confusion and poor left limb activity;Cerebral vasospasm occurred in 4 patients;Two patients developed hydrocephalus.After 6 months of discharge,patients in the two groups were followed up.There were no recurrent cases in the clamp group and 3 cases in the interventional group,with no statistically significant difference(P>0.05);There was no statistically significant difference in m RS scores(P>0.05).Six months after discharge,the SII of patients with poor prognosis significantly increased,and when the SII value was1646.89,it was considered the optimal cutoff value.The area under the curve(AUC)for predicting poor prognosis was 0.726(95% CI,0.551-0.901,P<0.05),with sensitivity and specificity of 90.9% and 57.1%,respectively.Conclusion:Both craniotomy and minimally invasive interventional surgery are effective treatments for PIA,but the incidence of surgical complications is lower.As a new inflammatory marker,SII can reflect the balance between local immunity and systemic inflammatory response.High SII indicates poor prognosis in patients with SAH,and has predictive value for prognosis. |
PDF Full Text Request