Journal of Neurosurgical Sciences 2021 Aug 03

DOI: 10.23736/S0390-5616.21.05366-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Microsurgical clipping of Unruptured Intracranial Aneurysms (UIA) by a single surgeon's experience: why we should definitely preserve the neurosurgical skills in our health areas

Biagia LA PIRA ¹, Veronica PICOTTI ¹, Marta ZAPPALÀ ¹, Vincenza MAIOLA ¹, Alessandro PESCE ², Alessandro FRATI ³, Antonio SANTORO ⁴, Giancarlo D'ANDREA ¹ ✉

¹ Azienda Ospedaliera Fabrizio Spaziani, Frosinone, Italy; ² Azienda Ospedaliera Santa Maria Goretti, Latina, Italy; ³ IRCCS Neuromed, Pozzill, Isernia, Italy; ⁴ Human Neurosciences Department, Sapienza University, Roma, Italy

BACKGROUND: The long standing comparison between the endovascular and microsurgical treatment is still ongoing. While not any center avails of a neuroendovascular service, and not every aneurysm is suitable for endovascular treatment, the neurovascular technique is slowly disappearing from our territories, whereas in the current Literature, the role of the neurosurgical treatment is being re-appreciated. The objective of this paper is to discuss a single surgeon’s clinical and radiological results with the microsurgical management of UIA.
METHODS: We retrospectively reviewed the clinical and radiological records of patients treated for UIA, by a single surgeon,in the period ranging between 2015 and 2019. We recorded all the relevant anatomic features of the aneurysm, saliencies of the surgical treatment, such as the need for temporary clipping, intraoperative rupture or postoperative complications. The results of the clinical and radiological follow-up examinations were recorded either.
RESULTS: Fifty-eight patient undergoing microsurgical clipping were included, harboring a total of 65 UIAs. CTA with 3D reconstructions was sufficient to reach a reliable preoperative planning in 46 patients (76%). A total of 94% of the cases were unchanged or neurologically unremarkable at follow-up. The presence of postoperative complications was associated to the neck size and predictor of a longer hospitalizations, as well as longer hospitalizations are associated to the patients’ age, size of the aneurysms and surgical times.
CONCLUSIONS: According to our experience, we believe that microsurgical clipping plays a critical role in the management of UIA, also on the ground of the encouraging results of the relevant Literature.

KEY WORDS: Intracranial aneurysm; Unruptured aneurysm; Microsurgical clipping