Giant Fusiform and Dolichoectatic Aneurysms of the Basilar Trunk and Vertebrobasilar Junction-Clinicopathological and Surgical Outcome.
Giant Fusiform and Dolichoectatic Aneurysms of the Basilar Trunk and Vertebrobasilar Junction-Clinicopathological and Surgical Outcome.
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DOI：
10.1093/neuros/nyaa317
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发表时间：
2020-12-15
期刊：
影响因子：
4.8
通讯作者：
Link MJ
中科院分区：
文献类型：
--
作者：
Nakatomi H;Kiyofuji S;Ono H;Tanaka M;Kamiyama H;Takizawa K;Imai H;Saito N;Shiokawa Y;Morita A;Flemming KD;Link MJ
基底动脉干和椎基底动脉交界处巨大梭形和长形扩张动脉瘤（BTVBJ-GFDA）是一种非常难治疗的动脉瘤，通过回顾性多中心队列研究，评价影响BTVBJ-GFDA生存率和预后的因素。本研究共纳入32例BTVBJ-GFDA患者。临床病理学特征，治疗措施和结果收集的医疗记录和影像学研究。9例还获得了动脉瘤和邻近脑组织的尸检和组织学发现。共有11例患者未接受手术，其中10例死亡; 3例死于进行性脑干压迫，4例死于蛛网膜下腔出血，2例死于脑干梗死，1例死于相关动脉粥样硬化疾病。其余21例患者接受了手术治疗，包括即刻近端载瘤动脉闭塞、远端近端载瘤动脉闭塞、成形夹重建和远端旁路移植术，与接受保守治疗的患者相比，总生存期显著延长（调整后风险比1.508，95% CI 1.058-2.148，P = 0.02）。动脉瘤的组织学检查显示了分期凝块、开放管腔和血栓内通道与内皮衬里。年龄小于45岁的患者的生存期在统计学上长于年龄等于和大于45岁的患者（P = 0.03）。在BTVBJ-GFDA中，手术干预比保守治疗获得了更高的生存率。应根据后交通动脉和穿支血管侧支的血流动力学，缩小动脉瘤内血流的理想治疗窗口，以维持充足但不过量的供应。
Giant fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction (BTVBJ-GFDA) are extremely difficult to treat. To evaluate factors influencing survival and outcome of BTVBJ-GFDA by performing a retrospective multicenter cohort study. A total of 32 patients with BTVBJ-GFDA were included in this study. Clinicopathological characteristics, treatment measures, and outcomes were collected from medical records and imaging studies. Autopsy and histological findings of the aneurysm and adjacent brain tissue were also obtained in 9 cases. A total of 11 patients did not undergo surgery, of whom 10 died; 3 from progressive brainstem compression, 4 from subarachnoid hemorrhage, 2 from brainstem infarction, and 1 from associated atherosclerotic disease. The remaining 21 patients underwent a surgical treatment, consisting of immediately proximal parent artery occlusion, remotely proximal parent artery occlusion, clip reconstruction, and distal bypass and achieved significantly longer overall survival compared with those who received conservative therapy (adjusted hazard ratio 1.508, 95% CI 1.058-2.148, P = .02). Histological examination of the aneurysms demonstrated staged clots, open lumen, and intrathrombotic channels with endothelial lining. The patients younger than 45 yr of age showed statistically longer survival than those equal and older than 45 yr (P = .03). Surgical intervention achieved greater survival than conservative management in BTVBJ-GFDA. Narrow ideal treatment window of the blood flow within the aneurysm to maintain sufficient but not excess supply should be targeted based on the hemodynamics of both the posterior communicating arteries and perforating vessel collaterals.
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影响因子：
8.3
作者：
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通讯作者：
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