Microsurgical clipping versus endovascular embolization in treating delayed cerebral ischemia after rupture of middle cerebral artery aneurysm

Objective To compare the effects of microsurgical clipping and endovascular embolization in treating rupture of middle cerebral artery aneurysm and their influences on delayed cerebral ischemia.

Methods The clinical materials of 96 patients with rupture of middle cerebral artery aneurysm were retrospectively collected, including 65 patients with microsurgical clipping (microsurgery group) and 31 patients with endovascular embolization (embolization group). Preoperative and postoperative immune function indicators, inflammatory indicators, perioperative indicators, incidence of delayed cerebral ischemia, and prognosis before and after surgery were compared between the two groups.

Results Compared with the microsurgery group, the embolization group had shorter operation time, less intraoperative bleeding volume and higher therapeutic cost, and the differences were statistically significant (P < 0.05). Three days after operation, the levels of immunoglobulin G (IgG), immunoglobulin M (IgM) and immunoglobulin A (IgA) in both groups were significantly lower than those before operation, and the levels of IgG, IgM and IgA in the microsurgery group were significantly lower than those in the embolization group (P < 0.05). Three days after operation, the levels of fibrinogen (Fib) and tumor necrosis factor-α (TNF-α) in both groups were significantly higher than those before operation, and the levels of Fib and TNF-α in the embolization group were significantly lower than those in the microsurgery group (P < 0.05). There were no significant differences in the incidence rates of delayed cerebral ischemia, mortality of cerebral ischemia and total incidence of postoperative complications between the two groups (P>0.05). The score of Barthel index and postoperative recurrence rate in the embolization group were significantly higher than those in the microsurgery group (P < 0.05).

Conclusion Both microsurgical clipping and endovascular embolization are effective methods for treating rupture of middle cerebral artery aneurysm, but endovascular embolization causes less trauma and milder immune suppression, which may be beneficial for reducing the risk of delayed cerebral ischemia after surgery. However, the postoperative recurrence rate and the treatment cost are higher for endovascular embolization.