The Choice of the Treatment Method for Cerebral Aneurysms of Different Locations in the Era of Advanced Endovascular Technologies: A Meta-Analysis

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  • Authors: Byval’tsev V.A.1,2,3,4, Belykh E.G.1, Stepanov I.A.3
  • Affiliations:
    1. Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk
    2. Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd., Irkutsk
    3. Irkutsk State Medical University, Irkutsk
    4. Irkutsk State Medical Academy of Postgraduate Education, Irkutsk
  • Issue: Vol 71, No 1 (2016)
  • Pages: 31-40
  • Section: CARDIOLOGY AND CARDIOVASCULAR SURGERY: CURRENT ISSUES
  • URL: https://vestnikramn.spr-journal.ru/jour/article/view/615
  • DOI: https://doi.org/10.15690/vramn615
  • Cite item

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. 


V. A. Byval’tsev

Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk;
Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd., Irkutsk;
Irkutsk State Medical University, Irkutsk;
Irkutsk State Medical Academy of Postgraduate Education, Irkutsk

Author for correspondence.
Email: byval75vadim@yandex.ru

Russian Federation

доктор медицинских наук, главный нейрохирург Департамента здравоохранения ОАО «РЖД», заведующий курсом нейрохирургии Иркутского государственного медицинского университета, ведущий научный сотрудник лаборатории БНЗТ ИЯФ СО РАН, заведующий научно-клиническим отделом нейрохирургии Иркутского научного центра хирургии и травматологии, , профессор кафедры травматологии, ортопедии и нейрохирургии Иркутской государственной медицинской академии последипломного образования 

E. G. Belykh

Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk

Email: e.belykh@yandex.ru

Russian Federation

аспирант

I. A. Stepanov

Irkutsk State Medical University, Irkutsk

Email: edmoilers@mail.ru

Russian Federation

аспирант курса нейрохирургии

  1. Крылов В.В. Хирургия аневризм головного мозга.– М.: Медицина; 2011. Т.I. 432 с. [Krylov VV. Khirurgiya anevrizm golovnogo mozga. Vol. I. Moscow: Meditsina; 2011. 432 p. (In Russ.)].
  2. Терехов В.С. Цереброваскулярные артериальные аневризмы и артериовенозные мальформации в республике Беларусь: клиническая эпидемиология и эпидемиологическое прогнозирование // Медицинский журнал. – 2011. – Т.2. – С.111−117. [Terekhov VS. Clinical epidemiology of cerebral aneurysms in present and anticipation of the republic of Belarus. Meditsinskii zhurnal. 2011;2:111−117. (In Russ.)]
  3. Higashida RT, Lahue BJ, Torbey MT, et al. Treatment of Unruptured Intracranial Aneurysms: A Nationwide Assessment of Effectiveness. Am J Neuroradiol. 2007;28(1):146−151.
  4. Rinne J, Hernesniemi J, Niskanen M, et al. Management outcome for multiple intracranial aneurysms. Neurosurgery. 1995;36(1):31−38. doi: 10.1097/00006123-199501000-00003.
  5. Lin N, Cahill KS, Frerichs KU, et al. Treatment of ruptured and unruptured cerebral aneurysms in the USA: a paradigm shift. J Neurointerv Surg. 2012;4(3):182−189. doi: 10.1136/jnis.2011.004978.
  6. Ribourtout E, Raymond J. Gene therapy and endovascular treatment of intracranial aneurysms. Stroke. 2004;35:786–793. doi: 10.1161/01.str.0000117577.94345.cc.
  7. Stehbens WE. Pathology of the Cerebral Blood Vessels. St. Louis: Mosby; 1972. 661 p.
  8. Хейреддин А.С., Филатов Ю.М., Белоусова О.Б., Шталенков М.А. Обоснование дифференцированной тактики ведения больных с множественными аневризмами // Вопросы нейрохирургии. – 2012. – Т. 3. – С. 45–53. [Heireddin AS, Filatov YM, Belousova OB, Shtalenkov MA. Obosnovanie differentsirovannoi taktiki vedeniya bol’nykh s mnozhestvennymi anevrizmami. Voprosy neirokhirurgii. 2012;3:45–53. (In Russ.)].
  9. Neyeloff JL, Fuchs SC, Moreira LB. Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes. 2012;20(2):45−52. doi: 10.1186/1756-0500-5-52.
  10. Ткачев В.В., Барабанова М.А., Музлаев Г.Г. Аневризматические внутричерепные кровоизлияния. Что мы о них знаем? // Российский нейрохирургический журнал имени проф. А.Л. Поленова. – 2010. – Т.2. – №4. – С. 10–27. [Tkachov VV, Barabanova MA, Muzlaev GG. Аneurysmal intracranial hemorrhages: what do we know about them? Rossiiskii neirokhirurgicheskii zhurnal imeni prof. A.L. Polenova. 2010;2(4):10–27. (In Russ.)].
  11. Виленский Б.С. Современная тактика борьбы с инсультом. – СПб.: Фолиант; 2005. 282 с. [Vilenskii BS. Sovremennaya taktika bor’by s insul’tom. Saint Petersburg: Foliant; 2005. 282 p. (In Russ.)].
  12. Keedy A. An overview of intracranial aneurysms. McGill J Med. 2006;9(2):141–146.
  13. Spetzler RF, Schuster H, Roski RA. Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. J Neurosurg. 1980;53(1):22–27. doi: 10.3171/jns.1980.53.1.0022.
  14. Лебедев И.А., Акинина С.А., Анищенко Л.И., и др. Нетравматические внутричерепные кровоизлияния в Ханты-Мансийском автономном округе: заболеваемость, смертность, структура, факторы риска // Вестник Северо-Западного государственного медицинского университета им. И.И. Мечникова. – 2011. – Т. 3. – №3. – С. 74–81. [Lebedev IA, Akinina SA, Anishchenko LI, et al. Non-traumatic intracranial hemorrages in the Khanty-Mansi autonomous district: morbidity, mortality, structure, risk factors. Vestnik Severo-Zapadnogo gosudarstvennogo meditsinskogo universiteta im. I.I. Mechnikova. 2011;3(3):74–81. (In Russ.)]
  15. Juvela S, Lehto H. Risk factors for all-cause death after diagnosis of unruptured intracranial aneurysms. Neurology. 2015;84(5):456−463. doi: 10.1212/wnl.0000000000001207.
  16. Свистов Д.В., Павлов О.А., Никитин А.И. Алгоритм хирургического лечения пациентов в остром периоде аневризматического кровоизлияния // Вестник Российской военно-медицинской академии. 2012;1(37):19–23. [Svistov DV, Pavlov OA, Nikitin AI, et al. Algorithm for the surgical treatment of patients in the acute period of aneurysmal hemorrhage. Vestnik Rossiiskoi Voenno-meditsinskoi akademii. 2012;1(37):19–23. (In Russ.)].
  17. Ghods AJ, Lopes D, Chen M. Gender Differences in Cerebral Aneurysm Location. Front Neurol. 2012;3. doi: 10.3389/fneur.2012.00078.
  18. Komotar RJ, Mocco J, Solomon RA. Guidelines for the surgical treatment of unruptured intracranial aneurysms. Neurosurgery. 2008;62(1):183–193. doi: 10.1227/01.NEU.0000311076.64109.2E.
  19. Пилипенко Ю.В., Элиава Ш.Ш., Яковлев С.Б., Мурзаев Л.Д. Анализ осложнений хирургического лечения аневризм головного мозга у больных, оперированных в отдаленном постгеморрагическом периоде // Вопросы нейрохирургии. – 2014. – Т. 2. – №2. – С. 32–38 [Pilipenko YV, Eliava SS, Yakovlev SB, Murzaev LD. Analiz oslozhnenii khirurgicheskogo lecheniya anevrizm golovnogo mozga u bol’nykh, operirovannykh v otdalennom postgemorragicheskom periode. Voprosy neirokhirurgii. 2014;2:32–38. (In Russ.)]
  20. Бывальцев В.А. Превентивная реваскуляризация ишемических и геморрагических инсультов. Автореф. дис. ... докт. мед. наук. – М.; 2010. 26 с. [Byvaltsev VA. Preventivnaya revaskulyarizatsiya ishemicheskikh i gemorragicheskikh insul’tov. [dissertation] Moscow; 2010. 26 p. (In Russ.)]
  21. Wiebers DO. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103−110. doi: http://dx.doi.org/10.1016/S0140-6736(03)13860-3.
  22. Kaku Y, Kokuzawa J, Hatsuda N, et al. Treatment of ruptured cerebral aneurysms ― clip and coil, not clip versus coil. Acta Neurochir Suppl. 2010;107:9−13. doi: 10.1007/978-3-211-99373-6-2.
  23. Natarajan SK, Sekhar LN, Ghodke BD, et al. Outcomes of ruptured intracranial aneurysms treated by microsurgical clipping and endovascular coiling in high-volume center. Am J Neuroradiol. 2008;29(4):753−759. doi: 10.3174/ajnr.A0895.
  24. Tenjin H, Takadou M, Ogawa T, et al. Treatment selection for ruptured aneurysm and outcomes: clipping or coil embolization. Neurol Med Chir. 2011;51(1):23−9. doi: 10.2176/nmc.51.23.
  25. Davies JM, Lawton MT. Advances in open microsurgery for cerebral aneurysms. Neurosurgery. 2014;74:7–16. doi: 10.1227/NEU.0000000000000193.
  26. Molyneux AJ, Kerr RS, Yu LM, et al. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized comparison of effects on survival, dependency, seizures, rebreeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488):809–817. doi: 10.1016/s0140-6736(05)67214-5.
  27. McDougall CG, Spetzler RF, Zambramski JM, et al. The Barrow Ruptured Aneurysm Trial. J Neurosurg. 2012;116(1):135–144. doi: 10.3171/2011.8.JNS101767.
  28. Spetzler RF, Sanai N. The quiet revolution: retractorless surgery for complex vascular and skull base lesions. J Neurosurg. 2012;116(2):291–300. doi: 10.3171/2011.8.jns101896.
  29. Darsaut TE, Jack AS, Kerr RS. International subarachnoid aneurysm trial ― ISAT Part II: Study protocol for a randomized controlled. Trials. 2013;14(156):1–8. doi: 10.1186/1745-6215-14-156.
  30. Spetzler RF, McDougall CG, Albuquerque FC, et al. The Barrow Ruptured Aneurysm Trial: 3 year results. J Neurosurg. 2013;119(1):146−57. doi: 10.3171/2013.3.JNS12683.
  31. Brown RD, Broderick JP. Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. Lancet Neurol. 2014;13(4):393–404. doi: 10.1016/S1474-4422(14)70015-8.
  32. Hernesniemi J, Koivisto T. Comments on «The impact of the International Subarachnoid Aneurysm Treatment Trial (ISAT) on neurosurgical practice». Acta Neurochir. 2004;146(2):203–208. doi: 10.1007/s00701-003-0098-y.
  33. Etminan N, Baeseoglu K, Barrow D, et al. Multidisciplinary consensus on assessment of unruptured intracranial aneurysms: proposal of an international research group. Stroke. 2014;45(5):1523–1530. doi: 10.1161/strokeaha.114.004519.
  34. Morita A, Kirino T, Hashi K, et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012;366(26):2474−2482. doi: 10.1056/nejmoa1113260.
  35. Martin N. Arterial bypass for the treatment of giant and fusiform intracranial aneurysms. Techniques in Neurosurgery. 1998;4(2):153-178.
  36. Fischer S, Vajda Z, Perez MA. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology. 2012;54(4):369–382. doi: 10.1007/s00234-011-0948-x.
  37. Tse MM, Yan BR, Dowling RG. Current status of pipeline embolization device in the treatment of intracranial aneurysms: a review. World Neurosurg. 2013;80(6):829–835. doi: 10.1016/j.wneu.2012.09.023.
  38. Chalouhi N, Starke RM, Yang S. Extending the indications of flow diversion to small, unruptured, saccular aneurysms of the anterior circulation. Stroke. 2014;45(1):54–58. doi: 10.1161/strokeaha.113.003038.
  39. Britz WG, Salem L, Newell DW. Impact of Surgical Clipping on Survival in Unruptured and Ruptured Cerebral Aneurysms: A Population Based Study. Stroke. 2004;35:1399–1403. doi: 10.1161/01.str.0000128706.41021.01.
  40. Islak C. The retreatment: indications, technique and results. Eur J Radiol. 2013;82(10):1659–1664. doi: 10.1016/j.ejrad.2012.12.025.
  41. Duan Y, Blackham K, Nelson J. Analysis of short term total hospital costs and current primary cost drivers of coiling versus clipping for unruptured intracranial aneurysms. J Neurointerv Surg. 2014;42(11):1239–1243. doi: 10.1136/neurintsurg-2014-011249.
  42. Nagamine Y. Natural history and management of asymptomatic unruptured cerebral aneurysms. Rinsho Shinkeigaku. 2004;44(11):763–766.

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