Peripheral intracranial aneurysms: management challenges in 60 consecutive cases
Peripheral intracranial aneurysms: management challenges in 60 consecutive cases
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DOI：
10.3171/2008.6.jns0814
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发表时间：
2009-01-01
影响因子：
4.1
通讯作者：
Nussbaum, Leslie A.
中科院分区：
文献类型：
--
作者：
Nussbaum, Eric S.;Madison, Michael T.;Nussbaum, Leslie A.
目的。作者报告了 55 例患者的治疗和结果，其中 60 个颅内动脉瘤发生在 Willis 环和椎基底动脉系统主要分支点的远端。方法。 1997 年 7 月至 2006 年 12 月期间，作者的神经血管服务治疗了 1850 名患者的 2021 例颅内动脉瘤。回顾性审查数据库以确定位于外周的颅内动脉瘤。真菌性动脉瘤和与所有动静脉畸形或心房粘液瘤相关的动脉瘤被排除在审查之外。结果。作者在 55 名患者中发现了 60 个周围颅内动脉瘤。有 42 个小病灶、7 个大病灶和 1 个巨大病灶。 41 例 (68%) 未破裂，19 例 (32%) 已出血。 53例动脉瘤的手术治疗方法为直接夹重建26例，诱捕或近端闭塞加远端血运重建2例，切除端端吻合3例，环周包裹/夹重建3例。其中6例采用弹簧圈治疗，1例采用血管内载瘤动脉闭塞治疗。总体而言，49 例患者预后良好，4 例出现新的神经功能缺损，2 例死亡。结论。位于周围的颅内动脉瘤是罕见的病变，带来了独特的治疗挑战。尽管根据作者的经验，这些病变很少可以通过简单地夹闭动脉瘤颈或血管内弹簧圈闭塞来治疗，但在大多数情况下保留载瘤动脉是可能的，并且大多数患者都有良好的结果。 （DOI：10.3171/2008.6.JNS0814）
Object. The authors report the management and outcomes of 55 patients with 60 intracranial aneurysms arising distal to the major branch points of the circle of Willis and vertebrobasilar system.Methods. Between July 1997 and December 2006, the authors' neurovascular service treated 2021 intracranial aneurysms in 1850 patients. The database was reviewed retrospectively to identify peripherally located intracranial aneurysms. Aneurysms that were mycotic and aneurysms that were associated with either ail arteriovenous malformation or an atrial myxoma were excluded from review.Results. The authors encountered 60 peripheral intracranial aneurysms in 55 patients. There were 42 small, 7 large, and I I giant lesions. Forty-one (68%) were unruptured, and 19 (32%) had bled. Fifty-three aneurysms were treated surgically by using direct clip reconstruction in 26, trapping or proximal occlusion with distal revascularization in 2 1, excision with end-to-end anastomosis in 3, and circumferential wrap/clip reconstruction in 3. Coils were used to treat 6 aneurysms, and I was treated by endovascular parent artery occlusion. Overall, 49 patients had good outcomes, 4 were left with new neurological deficits,and 2 died.Conclusions. Peripherally situated intracranial aneurysms are rare lesions that present unique management challenges. Despite the fact that in the authors experience these lesions were rarely treatable with simple clipping of the aneurysm neck or endovascular coil occlusion, preservation of the parent artery was possible in most cases, and the majority of patients had a good outcome. (DOI: 10.3171/2008.6.JNS0814)