PDF(Pubmed)
Abstract：
OBJECTIVE: The aim of this study is to analyze the effectiveness of our protocol of the use of multimodality tools, namely indocyanine green-dual image video angiography, neuroendoscope, neuromonitoring with motor-evoked potential, micro-Doppler in the microsurgical clipping of unruptured anterior circulation aneurysms, operated at our institute from January 2016 to December 2018.
METHODS: We performed a retrospective analysis of all cases of unruptured anterior circulation aneurysms, operated at Fujita Health University Banbuntane-Hotokukai Hospital, Japan, from January 2016 to December 2018. We assessed outcome at immediate postoperative, at discharge, and at 3 months follow-up by defining permanent morbidity as drop in Modified Rankin Scale (MRS) by 1 at 3 months follow-up and transient morbidity as temporary deficit that improved at discharge or follow-up. Postoperative events, namely seizures, infection that did not affect/change. Preoperative MRS and discharge timing were excluded. We concluded poor outcome as MRS ≥3 and good outcome as MRS < 3 (0-2). All patients had a minimum of 3 months follow-up before outcome conclusion.
RESULTS: In 2016, a total of 98 cases were operated with no mortality or permanent morbidity (i.e., change in preoperative MRS), only transient morbidity was seen in (two cases) 2.04%. In 2017, a total of 119 cases were operated with no mortality or morbidity. In 2018, a total of 130 cases were operated with no mortality or permanent morbidity, only transient morbidity 0.7%. Summarizing from January 2016 to December 2018, a total of 347 cases of anterior circulation aneurysms were operated. Mostly, in the female sex (73.3%), the most common was middle cerebral artery aneurysm (39.1%). The mean size was 5.3 mm with no mortality or permanent morbidity with only transient morbidity in 0.9%. No poor outcome (MRS ≥3) was seen in our series.
CONCLUSIONS: In our center for most unruptured anterior circulation aneurysms, microsurgical clipping is the treatment of choice. We believe our protocol of the intra-operative usage of multimodality tools have aided in the safe microsurgical clipping and have consistently resulted in good operative outcomes. Hence, we recommend and continue to use our Fujita-Bantane Protocol in all cases of micro-surgical clipping of aneurysms to consistently achieve good operative outcomes.
METHODS: We performed a retrospective analysis of all cases of unruptured anterior circulation aneurysms, operated at Fujita Health University Banbuntane-Hotokukai Hospital, Japan, from January 2016 to December 2018. We assessed outcome at immediate postoperative, at discharge, and at 3 months follow-up by defining permanent morbidity as drop in Modified Rankin Scale (MRS) by 1 at 3 months follow-up and transient morbidity as temporary deficit that improved at discharge or follow-up. Postoperative events, namely seizures, infection that did not affect/change. Preoperative MRS and discharge timing were excluded. We concluded poor outcome as MRS ≥3 and good outcome as MRS < 3 (0-2). All patients had a minimum of 3 months follow-up before outcome conclusion.
RESULTS: In 2016, a total of 98 cases were operated with no mortality or permanent morbidity (i.e., change in preoperative MRS), only transient morbidity was seen in (two cases) 2.04%. In 2017, a total of 119 cases were operated with no mortality or morbidity. In 2018, a total of 130 cases were operated with no mortality or permanent morbidity, only transient morbidity 0.7%. Summarizing from January 2016 to December 2018, a total of 347 cases of anterior circulation aneurysms were operated. Mostly, in the female sex (73.3%), the most common was middle cerebral artery aneurysm (39.1%). The mean size was 5.3 mm with no mortality or permanent morbidity with only transient morbidity in 0.9%. No poor outcome (MRS ≥3) was seen in our series.
CONCLUSIONS: In our center for most unruptured anterior circulation aneurysms, microsurgical clipping is the treatment of choice. We believe our protocol of the intra-operative usage of multimodality tools have aided in the safe microsurgical clipping and have consistently resulted in good operative outcomes. Hence, we recommend and continue to use our Fujita-Bantane Protocol in all cases of micro-surgical clipping of aneurysms to consistently achieve good operative outcomes.
摘要：
■这项研究的目的是分析我们使用多模态工具的协议的有效性，即吲哚菁绿-双图像视频血管造影，神经内窥镜,具有运动诱发电位的神经监测，微多普勒在未破裂的前循环动脉瘤的显微外科手术夹闭中，于2016年1月至2018年12月在我们的研究所运营。
■我们对所有未破裂的前循环动脉瘤病例进行了回顾性分析，在藤田健康大学Banbuntane-Hotokukai医院手术，Japan,从2016年1月到2018年12月。我们评估了术后即刻的结果，在放电时，在3个月的随访中，通过将永久性发病率定义为改良Rankin量表（MRS）在3个月的随访中下降1，将暂时性发病率定义为在出院或随访时改善的暂时性缺陷。术后事件,即癫痫发作，没有影响/改变的感染。术前MRS和出院时间排除。我们得出的结果为MRS≥3，结果为MRS<3（0-2）。所有患者在结局结论前至少随访3个月。
■2016年，共有98例手术，无死亡率或永久性发病率（即，术前MRS的变化)，只有一过性发病率(2例)为2.04%。2017年，共手术119例，无死亡率或发病率。2018年，共手术130例，无死亡率或永久性发病率，只有短暂的发病率0.7%。总结2016年1月至2018年12月共手术治疗前循环动脉瘤347例。大多数情况下,女性（73.3%）最常见的是大脑中动脉瘤(39.1%)。平均大小为5.3mm，无死亡率或永久性发病率，仅有短暂发病率为0.9％。在我们的系列中没有发现不良结果（MRS≥3）。
■在我们大多数未破裂的前循环动脉瘤中心，显微外科手术夹闭是治疗的选择。我们相信，我们在术中使用多模态工具的协议有助于安全的显微外科手术夹闭，并始终取得良好的手术效果。因此，我们建议并继续在所有动脉瘤显微手术夹闭病例中使用Fujita-Bantane方案,以持续获得良好的手术结局.
■我们对所有未破裂的前循环动脉瘤病例进行了回顾性分析，在藤田健康大学Banbuntane-Hotokukai医院手术，Japan,从2016年1月到2018年12月。我们评估了术后即刻的结果，在放电时，在3个月的随访中，通过将永久性发病率定义为改良Rankin量表（MRS）在3个月的随访中下降1，将暂时性发病率定义为在出院或随访时改善的暂时性缺陷。术后事件,即癫痫发作，没有影响/改变的感染。术前MRS和出院时间排除。我们得出的结果为MRS≥3，结果为MRS<3（0-2）。所有患者在结局结论前至少随访3个月。
■2016年，共有98例手术，无死亡率或永久性发病率（即，术前MRS的变化)，只有一过性发病率(2例)为2.04%。2017年，共手术119例，无死亡率或发病率。2018年，共手术130例，无死亡率或永久性发病率，只有短暂的发病率0.7%。总结2016年1月至2018年12月共手术治疗前循环动脉瘤347例。大多数情况下,女性（73.3%）最常见的是大脑中动脉瘤(39.1%)。平均大小为5.3mm，无死亡率或永久性发病率，仅有短暂发病率为0.9％。在我们的系列中没有发现不良结果（MRS≥3）。
■在我们大多数未破裂的前循环动脉瘤中心，显微外科手术夹闭是治疗的选择。我们相信，我们在术中使用多模态工具的协议有助于安全的显微外科手术夹闭，并始终取得良好的手术效果。因此，我们建议并继续在所有动脉瘤显微手术夹闭病例中使用Fujita-Bantane方案,以持续获得良好的手术结局.
