Global Outcomes for Microsurgical Clipping of Unruptured Intracranial Aneurysms: A Benchmark Analysis of 2245 Cases

被引：8

作者：

Drexler, Richard ^{[1
]}

Sauvigny, Thomas ^{[1
]}

Pantel, Tobias F. ^{[1
]}

Ricklefs, Franz L. ^{[1
]}

Catapano, Joshua S. ^{[2
]}

Wanebo, John E. ^{[2
]}

Lawton, Michael T. ^{[2
]}

Sanchin, Aminaa ^{[3
]}

Hecht, Nils ^{[3
]}

Vajkoczy, Peter ^{[3
]}

Raygor, Kunal ^{[4
]}

Tonetti, Daniel ^{[4
]}

Abla, Adib ^{[4
]}

El Naamani, Kareem ^{[5
]}

Tjoumakaris, Stavropoula I. ^{[5
]}

Jabbour, Pascal ^{[5
]}

Jankowitz, Brian T. ^{[6
]}

Salem, Mohamed M. ^{[6
]}

Burkhardt, Jan-Karl ^{[6
]}

Wagner, Arthur ^{[7
]}

Wostrack, Maria ^{[7
]}

Gempt, Jens ^{[1
,7
]}

Meyer, Bernhard ^{[7
]}

Gaub, Michael ^{[8
]}

Mascitelli, Justin R. ^{[8
]}

Dodier, Philippe ^{[9
]}

Bavinzski, Gerhard ^{[9
]}

Roessler, Karl ^{[9
]}

Stroh, Nico ^{[10
]}

Gmeiner, Matthias ^{[10
]}

Gruber, Andreas ^{[10
]}

Figueiredo, Eberval G. ^{[11
]}

Samaia da Silva Coelho, Antonio Carlos ^{[11
]}

Bervitskiy, Anatoliy V. ^{[12
]}

Anisimov, Egor D. ^{[12
]}

Rzaev, Jamil A. ^{[12
]}

Krenzlin, Harald ^{[13
]}

Keric, Naureen ^{[13
]}

Ringel, Florian ^{[13
]}

Park, Dougho ^{[14
]}

Kim, Mun-Chul ^{[14
]}

Marcati, Eleonora ^{[15
]}

Cenzato, Marco ^{[15
]}

Westphal, Manfred ^{[1
]}

Duehrsen, Lasse ^{[1
]}

机构：

[1] Univ Med Ctr Hamburg Eppendorf, Dept Neurosurg, Martinistr 52, D-20246 Hamburg, Germany

[2] St Josephs Hosp, Barrow Neurol Inst, Dept Neurosurg, Phoenix, AZ USA

[3] Charite Univ Med Berlin, Dept Neurosurg, Berlin, Germany

[4] Univ Calif San Francisco, Dept Neurol Surg, San Francisco, CA USA

[5] Thomas Jefferson Univ Hosp, Dept Neurol Surg, Philadelphia, PA USA

[6] Hosp Univ Penn, Dept Neurosurg, Penn Med, Philadelphia, PA USA

[7] Tech Univ Munich TUM, Sch Med, Dept Neurosurg, Klinikum Rechts Isar, Munich, Germany

[8] Univ Texas Hlth & Sci Ctr San Antonio, Dept Neurosurg, San Antonio, TX USA

[9] Med Univ Vienna, Dept Neurosurg, Vienna, Austria

[10] Kepler Univ Hosp, Johannes Kepler Univ, Dept Neurosurg, Linz, Austria

[11] Univ Sao Paulo, Hosp Clin, Fac Med, Div Neurol Surg, Sao Paulo, Brazil

[12] Fed Ctr Neurosurg, Novosibirsk, Russia

[13] Univ Hosp Mainz, Dept Neurosurg, Mainz, Germany

[14] Pohang Stroke & Spine Hosp, Dept Neurosurg, Pohang, South Korea

[15] Grande Osped Metropolitano Niguarda, Dept Neurosurg, Milan, Italy

来源：

NEUROSURGERY | 2024年 / 94卷 / 02期

关键词：

Aneurysm; UIA; Outcome; Clipping; Microsurgery; Microsurgical; CEREBRAL ANEURYSMS; NATURAL-HISTORY; ENDOVASCULAR TREATMENT; SURGICAL-TREATMENT; MANAGEMENT; MORBIDITY; MORTALITY; RUPTURE; SURGERY; SAFETY;

D O I：

10.1227/neu.0000000000002689

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND AND OBJECTIVES: Benchmarks represent the best possible outcome and help to improve outcomes for surgical procedures. However, global thresholds mirroring an optimal and reachable outcome for microsurgical clipping of unruptured intracranial aneurysms (UIA) are not available. This study aimed to define standardized outcome benchmarks in patients who underwent clipping of UIA. METHODS: A total of 2245 microsurgically treated UIA from 15 centers were analyzed. Patients were categorized into low- ("benchmark") and high-risk ("nonbenchmark") patients based on known factors affecting outcome. The benchmark was defined as the 75th percentile of all centers' median scores for a given outcome. Benchmark outcomes included intraoperative (eg, duration of surgery, blood transfusion), postoperative (eg, reoperation, neurological status), and aneurysm-related factors (eg, aneurysm occlusion). Benchmark cutoffs for aneurysms of the anterior communicating/anterior cerebral artery, middle cerebral artery, and posterior communicating artery were determined separately. RESULTS: Of the 2245 cases, 852 (37.9%) patients formed the benchmark cohort. Most operations were performed for middle cerebral artery aneurysms (53.6%), followed by anterior communicating and anterior cerebral artery aneurysms (25.2%). Based on the results of the benchmark cohort, the following benchmark cutoffs were established: favorable neurological outcome (modified Rankin scale <= 2) >= 95.9%, postoperative complication rate <= 20.7%, length of postoperative stay <= 7.7 days, asymptomatic stroke <= 3.6%, surgical site infection <= 2.7%, cerebral vasospasm <= 2.5%, new motor deficit <= 5.9%, aneurysm closure rate >= 97.1%, and at 1-year follow-up: aneurysm closure rate >= 98.0%. At 24 months, benchmark patients had a better score on the modified Rankin scale than nonbenchmark patients. CONCLUSION: This study presents internationally applicable benchmarks for clinically relevant outcomes after microsurgical clipping of UIA. These benchmark cutoffs can serve as reference values for other centers, patient registries, and for comparing the benefit of other interventions or novel surgical techniques.

引用

页码：369 / 378

页数：10

共 45 条

[1] Procedural Clinical Complications, Case-Fatality Risks, and Risk Factors in Endovascular and Neurosurgical Treatment of Unruptured Intracranial Aneurysms A Systematic Review and Meta-analysis [J].

Algra, Annemijn M. ;

Lindgren, Antti ;

Vergouwen, Mervyn D. I. ;

Greving, Jacoba P. ;

van der Schaaf, Irene C. ;

van Doormaal, Tristan P. C. ;

Rinkel, Gabriel J. E. .

JAMA NEUROLOGY, 2019, 76 (03) :282-293

[2] The Benefits of Benchmarking-A New Perspective on Measuring Quality in Surgery [J].

Barkun, Jeffrey ;

Clavien, Pierre ;

Pawlik, Timothy M. .

JAMA SURGERY, 2023, 158 (04) :341-342

[3] Predicting inpatient complications from cerebral aneurysm clipping: the Nationwide Inpatient Sample 2005-2009 [J].

Bekelis, Kimon ;

Missios, Symeon ;

Mackenzie, Todd A. ;

Desai, Atman ;

Fischer, Adina ;

Labropoulos, Nicos ;

Roberts, David W. .

JOURNAL OF NEUROSURGERY, 2014, 120 (03) :591-598

[4] Role of calcification in the outcomes of treated, unruptured, intracerebral aneurysms [J].

Bhatia, Sanjay ;

Sekula, Raymond F. ;

Quigley, Matthew R. ;

Williams, Robert ;

Ku, Andrew .

ACTA NEUROCHIRURGICA, 2011, 153 (04) :905-911

[5] Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening [J].

Brown, Robert D., Jr. ;

Broderick, Jrioseph P. .

LANCET NEUROLOGY, 2014, 13 (04) :393-404

[6] Reoperation and readmission after clipping of an unruptured intracranial aneurysm: a National Surgical Quality Improvement Program analysis [J].

Dasenbrock, Hormuzdiyar H. ;

Smith, Timothy R. ;

Rudy, Robert F. ;

Gormley, William B. ;

Aziz-Sultan, M. Ali ;

Du, Rose .

JOURNAL OF NEUROSURGERY, 2018, 128 (03) :756-767

[7] European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms [J].

Etminan, Nima ;

de Sousa, Diana Aguiar ;

Tiseo, Cindy ;

Bourcier, Romain ;

Desal, Hubert ;

Lindgren, Anttii ;

Koivisto, Timo ;

Netuka, David ;

Peschillo, Simone ;

Lemeret, Sabrina ;

Lal, Avtar ;

Di Vergouwen, Mervyn ;

Rinkel, Gabriel Je .

EUROPEAN STROKE JOURNAL, 2022, 7 (03) :V-V

[8] Unruptured intracranial aneurysms: development, rupture and preventive management [J].

Etminan, Nima ;

Rinkel, Gabriel J. .

NATURE REVIEWS NEUROLOGY, 2016, 12 (12) :699-713

[9] Evolution of open surgery for unruptured intracranial aneurysms over a fifteen year period-increased difficulty and morbidity [J].

Gaub, Michael ;

Kromenacker, Bryan ;

Avila, Mauricio J. ;

Gonzales-Portillo, Gabriel S. ;

Aguilar-Salinas, Pedro ;

Dumont, Travis M. .

JOURNAL OF CLINICAL NEUROSCIENCE, 2023, 107 :178-183

[10] How to Establish Benchmarks for Surgical Outcomes? A Checklist Based on an International Expert Delphi Consensus [J].

Gero, Daniel ;

Muller, Xavier ;

Staiger, Roxane D. ;

Gutschow, Christian A. ;

Vonlanthen, Rene ;

Bueter, Marco ;

Clavien, Pierre-Alain ;

Puhan, Milo A. .

ANNALS OF SURGERY, 2022, 275 (01) :115-120

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