Microsurgical clipping and endovascular treatment of middle cerebral artery aneurysms in an interdisciplinary treatment concept: Comparison of long-term results

Schwartz, Christoph; Aster, Hans-Christoph; Al-Schameri, Rahman; Müller-Thies-Broussalis, Erasmia; Griessenauer, Christoph J.; Killer‐Oberpfalzer, Monika

doi:10.1177/1591019918792231

Cited by 27 publications

(20 citation statements)

References 23 publications

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“…Particularly with regard to the Web group, we observed a clear learning curve, so our data may underestimate the potential of the WEB device in this challenging subgroup of aneurysms. Otherwise in contrast to other studies, 3 we have a very limited selection bias for endovascular treatment. This shows that a wide variety of complex MCA bifurcation aneurysms can be treated using endovascular means alone.…”

Section: Limitationsmentioning

confidence: 73%

“…Recent publications demonstrate good clinical outcomes and low complication rates for both methods. 3,4 An essential point is that when we compared the 2 methods, the investigation objective is the same. Therefore, we present our endovascular treatment data of MCA bifurcation aneurysms from 2 hospitals (Klinikum Augsburg and Schoen Klinik, Vogtareuth, Germany).…”

mentioning

confidence: 99%

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Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up

Hagen

Maurer

Berlis

2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: The optimal treatment of unruptured middle cerebral aneurysms is still under debate. Although today almost any aneurysm can be treated endovascularly, there is a lack of data comparing endovascular and microsurgical repair of MCA aneurysms. The aim of our analysis is to provide data on the efficacy, clinical outcome, complications and re-treatment rates of endovascular treatment of this subtype of aneurysms. MATERIALS AND METHODS: Between May 2008 and July 2017, endovascular treatment of 1184 aneurysms in 827 patients was performed in our department. Twenty-four percent of these aneurysms were located at the MCA, and 150 unruptured MCA bifurcation aneurysms treated with coiling, stent-assisted-coiling, or endovascular flow diverter (WEB device) were identified for this retrospective data analysis. Ninety-six percent of all aneurysms, ruptured and unruptured, were treated by an endovascular approach, which yields a low selection bias for aneurysms suitable for endovascular treatment. Follow-up examinations were performed after 12 and 36 months and then every 1-3 years after embolization. Procedures were analyzed for periprocedural complications, outcome, and retreatment rate of the WEB (n ϭ 38) and coiling with (n ϭ 45) or without stent assistance (n ϭ 67). RESULTS: The procedure-associated good clinical outcome (mRS Ϲ 2) was 89.9%, and the mortality rate was 2.7%. Short-term follow-up good clinical outcome/mortality rates were 91.3%/0.7%. At discharge, 137 patients had an mRS of 0-2 (91.3%) and 13 had an mRS of 3-6 (8.7%). The retreatment rate was significantly higher in the WEB group (21.1%) compared with the coiling group with (5.9%) or without (2.2%) stent placement (P Ͻ .05). CONCLUSIONS: Regardless of the architecture of MCA bifurcation aneurysms, the endovascular treatment can be performed with low morbidity/mortality rates. The higher retreatment rate in the WEB group correlates with the learning curve in choosing the right device size.

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Section: Limitationsmentioning

confidence: 73%

mentioning

confidence: 99%

Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up

Hagen

Maurer

Berlis

2019

AJNR Am J Neuroradiol

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“…As per a paper published by David et al in 1999, occlusion rates were around 90% [ 29 ]. A more recently published retrospective study involving 92 patients with MCA aneurysms, of which 54 underwent clipping, found the post-clipping occlusion rate to be 96.3% [ 30 ]. A meta-analysis published by Toccaceli et al concluded that the long-term complete occlusion rate after surgery is 95%, thus strengthening the previous studies’ findings [ 31 ].…”

Section: Reviewmentioning

confidence: 99%

Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms

Belavadi¹,

Gudigopuram²,

Raguthu³

et al. 2021

Cureus

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Intracranial aneurysms are pathological dilatations of intracranial arteries and prevail in around 3.2% of the general population. The worst outcome of an aneurysm is its rupture. Its prevention and management can be accomplished by two broad modalities: surgical clipping and endovascular coiling. This review has explored each of these approaches individually and has then directly compared them to provide a good understanding of their respective advantages and disadvantages over one another. Clipping is associated with a higher rate of occlusion of the aneurysm and lower rates of residual and recurrent aneurysms, whereas coiling is associated with lower morbidity and mortality and a better postoperative course. The risks and benefits of each of these procedures must be thoroughly examined in each case. This article has stressed the need to consider all contributing patient, procedure-related, surgeon-related, and hospital factors before arriving at a final decision to manage a specific case.

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“…Treatment of exposed steel plates after surgery for fractures of foot and ankle is complicated, and presently, microsurgical repair treatment is a particularly advanced method used to clean the wound (4). Microsurgery is a subject of fine operations on fine tissues using optical magnification.…”

Section: Introductionmentioning

confidence: 99%

Effects of microsurgical repair treatment on the clinical efficacy, complications, and flap follow-up scores of patients with exposed steel plates after surgery for foot and ankle fractures

et al. 2020

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Background: Treatment of exposed steel plates after surgery for foot and ankle fractures is complicated.This study aims to analyze the effects of microsurgical repair treatment on the clinical efficacy, complications, and flap follow-up scores of patients with exposed steel plates following foot and ankle fracture surgery.Methods: Eighty-two patients with exposure of steel plates after surgical treatment for foot and ankle fractures in our hospital from March 2017 to March 2018 were included in this study. The patients were divided into a study group (43 patients who received microsurgical repair) and a control group (39 patients who received conventional repair surgery). We compared the clinical efficacy, complication rate, flap followup score, recovery of ankle-hindfoot function and ankle function before treatment and at 3 and 6 months after treatment, and patient satisfaction between the two groups.Results: The clinical effectiveness rate in the study group was 95.35%, which was higher than the control group (76.92%) (P<0.05). The flap appearance, texture, and elasticity scores in the study group were higher than those in the control group (P<0.05). After treatment, the American Orthopedic Foot and Ankle Society (AOFAS) score and Baird ankle score increased significantly in both groups, and reached a peak at 6 months after treatment. The peak scores of the study group were considerably higher than those of the control group at each period after treatment (P<0.05). The incidence of complications in the study group (6.98%) was lower than the control group (25.64%) (P<0.05). Patient satisfaction was higher in the study group (97.67%) than the control group (79.49%) (P<0.05).Conclusions: Microsurgical repair of exposed steel plates after surgery for foot and ankle fractures has a significant clinical effect. It can improve the flap follow-up scores, accelerate healing of the ankle, improve aesthetics, and reduce the incidence of complications. It is therefore worthy of widespread use in clinics.

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Microsurgical clipping and endovascular treatment of middle cerebral artery aneurysms in an interdisciplinary treatment concept: Comparison of long-term results

Cited by 27 publications

References 23 publications

Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up

Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up

Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms

Effects of microsurgical repair treatment on the clinical efficacy, complications, and flap follow-up scores of patients with exposed steel plates after surgery for foot and ankle fractures

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