Abstract：
Treating blood blister-like aneurysms (BBA) is a major neurosurgical challenge. Whether endovascular repair serves as a better strategy than microsurgery remains controversial. We aim to perform a propensity score-matched (PSM) retrospective study to analyze the short-term outcome in BBA patients who received microsurgery and endovascular treatment. One hundred fifty-five eligible patients with internal carotid artery BBA were retrospectively collected with demographic and angiographic baseline in a single center. Three-month outcome and adverse events were set as outcome endpoints. PSM was used to match the microsurgery and endovascular group. Matching effect was evaluated by distribution variation analysis and love plot. The outcome of neurosurgery and endovascular treatment was then compared before and after PSM. Better WFNS levels (p = .017) and modified Fisher grade (p = .027) were noted in endovascular group before matching. Other baseline including angiographic features were comparable between two groups. Before matching, the 3-month outcome of endovascular repair surgery was more favorable than microsurgery (p < .0001). The occurrence of adverse events was also higher in the microsurgery group (p = .0079). In PSM-adjusted groups, the superior outcome effect of endovascular treatment still existed but with a reduced significance (p = .004). Similar trend was also observed in the adverse event rate (p = .038). Fatality rate was comparable between two adjusted groups regardless of PSM adjustment. Endovascular surgery of BBAs exhibits overall more favorable short-term outcome regardless of PSM matching. Microsurgery does not cause a higher fatality rate, hence it could be considered a salvage plan for those high-grade BBA patients.
摘要：
治疗血泡状动脉瘤（BBA）是神经外科的主要挑战。血管内修复是否比显微外科手术更好，仍存在争议。我们旨在进行倾向评分匹配（PSM）回顾性研究，以分析接受显微外科手术和血管内治疗的BBA患者的短期预后。回顾性收集了125例符合颈内动脉BBA的患者，并在单个中心进行了人口统计学和血管造影基线检查。将三个月的结果和不良事件设定为结果终点。PSM用于匹配显微手术和血管内组。通过分布变异分析和爱情图评价匹配效果。然后比较PSM前后神经外科手术和血管内治疗的结果。在匹配之前，血管内观察到更好的WFNS水平（p=.017）和改良的Fisher等级（p=.027）。包括血管造影特征在内的其他基线在两组之间具有可比性。匹配之前,腔内修复手术的3个月结局比显微外科手术更有利(p<.0001).显微手术组的不良事件发生率也较高（p=.0079）。在PSM调整后的组中，血管内治疗的优越结局效果仍然存在,但显著性降低(p=.004).在不良事件发生率中也观察到类似的趋势(p=.038)。无论PSM调整如何，两个调整组之间的死亡率相当。无论PSM匹配如何，BBA的血管内手术总体上都表现出更有利的短期结果。显微外科手术不会导致更高的死亡率，因此,对于那些高级别BBA患者,可以考虑采取救助计划.
