目标:颅内动脉瘤存在重大健康风险,因为它们的破裂会导致蛛网膜下腔出血,这反过来又有很高的发病率和死亡率。有几个因素会影响颅内动脉瘤的复杂性。然而,在开放手术和血管内治疗中定义复杂颅内动脉瘤(CIA)的标准可能不同,实际上,对“复杂”动脉瘤的定义没有共识。这项DELPHI研究旨在评估定义aCIA的变量的共识。
方法:由50名成员组成的国际小组,代表各种专业,被招募通过三轮德尔菲过程定义为。小组成员参加了Likert量表回答和开放式问题的调查。建立了共识标准来确定CIA变量,统计分析评估了共识和稳定性。
结果:在开放手术中,CI由梭形或水泡状定义,解剖病因,巨型尺寸(≥25毫米),宽颈包裹着父母的动脉,广泛的颈部表面,壁钙化,管腔内血栓,囊的附属分支,位置(AICA,SCA,basilar),血管痉挛背景,和计划旁路(EC-IC或IC-IC)。对于血管内治疗,CI包括巨大的尺寸,非常宽的颈部(圆顶/颈部比例≤1:1),和囊的附属分支。
结论:动脉瘤复杂性的定义因治疗方式而异。由于与复杂性相关的要素在开放手术和血管内治疗之间有所不同,CIAs的这些共识标准甚至可以指导选择最佳治疗方法。
OBJECTIVE: Intracranial aneurysms present significant health risks, as their rupture leads to subarachnoid haemorrhage, which in turn has high morbidity and mortality rates. There are several elements affecting the complexity of an intracranial aneurysm. However, criteria for defining a complex intracranial aneurysm (CIA) in open surgery and endovascular treatment could differ, and actually there is no consensus on the definition of a \"complex\" aneurysm. This DELPHI
study aims to assess consensus on variables defining a CIA.
METHODS: An international panel of 50 members, representing various specialties, was recruited to define CIAs through a three-round Delphi process. The panelists participated in surveys with Likert scale responses and open-ended questions. Consensus criteria were established to determine CIA variables, and statistical analysis evaluated consensus and stability.
RESULTS: In open surgery, CIAs were defined by fusiform or blister-like shape, dissecting aetiology, giant size (≥ 25 mm), broad neck encasing parent arteries, extensive neck surface, wall calcification, intraluminal thrombus, collateral branch from the sac, location (AICA, SCA, basilar), vasospasm context, and planned bypass (EC-IC or IC-IC). For endovascular treatment, CIAs included giant size, very wide neck (dome/neck ratio ≤ 1:1), and collateral branch from the sac.
CONCLUSIONS: The definition of aneurysm complexity varies by treatment modality. Since elements related to complexity differ between open surgery and endovascular treatment, these consensus criteria of CIAs could even guide in selecting the best treatment approach.