Effects of therapeutic methods on cerebral hemodynamics and cerebral energy metabolism in patients with cerebral aneurysms: clipping vs.endovascular embolization

ZHOU Zhi

doi:10.13798/j.issn.1009-153X.2017.06.015

Abstract：Objective To compare the changes in the cerebral hemodynamics and cerebral energy metabolism produced by clipping (craniotomy) with those by endovascular embolization in the patients with cerebral aneurysms.Methods Of 134 patients with cerebral aneurysms,65 (clipping group) underwent craniotomy from the clipping of aneurysms and 69 (embolization group) were treated by endovascular embolization from August,2013 to August,2016.The curative effects and changes in cerebral hemodynamics and cerebral energy metabolism were observed and compared between both the groups.Results There were no significant differences in the scores of GOS and mRS after the treatment between both the groups (P＞0.05).The rate of occurrence of aneurysm rupture was significantly higher in embolization group than that in clipping group (P＜0.05).The mean arterial pressure [(75.26± 12.12) mm Hg] was significantly lower in clipping group than that [(82.24±11.34) mmHg] in embolization group (P＜0.05),but glucose uptake rate in clipping group was significantly higher in clipping group than that in embolization group (P＜0.05) immediately after the treatment.There were no significant differences in heart rate,hemoglobin level,hematocrit value,intracranial pressure,glucose concentration,cerebral blood flow,pyruvic acid concentration,difference between the cerebral arterial oxygen content and jugular venous oxygen content and difference between jugular venous lactic acid content and cerebral arterial lactic acid content between both the two groups (P＞0.05).Conclusions There is insignificant difference in the clinical curative effects on the cerebral aneurysms between the clipping and endovascular embolization.The rate of aneurysm rupture occurrence was significantly lower in the patients undergoing the clipping than that in the patients undergoing endovascular embolization,but the endovascular embolization can better maintain relatively stable hemodynamics and cerebral energy metabolism compared to the clipping in the patients with cerebral aneurysms.