Current results of the surgical management of aneurysms of the basilar apex.
Current results of the surgical management of aneurysms of the basilar apex.
复制标题
基底动脉瘤手术治疗的最新结果。
DOI：
10.1097/00006123-199904000-00001
复制
发表时间：
1999
期刊：
影响因子：
4.8
通讯作者：
T. Kopitnik
中科院分区：
文献类型：
--
作者：
D. Samson;H. Batjer;T. Kopitnik
目的
提供关于基底动脉尖部动脉瘤现代外科治疗中预期临床结局以及发病率和死亡率来源的当前信息。
方法
对一家机构18年间手术治疗的303例此类动脉瘤进行了回顾性分析。81%的病例进行了术后血管造影。在出院时和术后6个月时对91%的存活患者使用格拉斯哥结局量表进行临床分级。通过使用单因素和多因素分析确定与不良临床结局统计学相关的术前参数。
结果
超过80%的患者使用经侧裂暴露的一些修改进行手术，并且常规使用临时动脉闭塞。出院时76%的患者和术后6个月时81%的患者结局良好（格拉斯哥结局量表评分为4或5分）。术后未发生蛛网膜下腔出血。6%的病例术后血管造影显示残余动脉瘤。与不良结局有统计学关联的因素包括入院分级差（Hunt和Hess IV和V级）、患者年龄大于65岁、计算机断层扫描显示厚基底池凝块、动脉瘤尺寸大于20 mm和脑干压迫引起的症状。
结论
基底动脉尖部动脉瘤的直接显微手术修复应在80 - 85%的病例中获得良好的临床结局，可靠地预防蛛网膜下腔出血，并常规消除/减轻继发于肿块效应的症状。在接受手术前，可以通过存在某些临床、影像学和人口统计学特征来识别具有不良结局高风险的患者，如果证明此类治疗的长期疗效，则可以考虑采用替代或替代治疗模式。
OBJECTIVE
To provide current information regarding the expected clinical outcomes and sources of morbidity and mortality in the modern surgical management of basilar apex aneurysms.
METHOD
A retrospective review was conducted of 303 cases of such aneurysms that were treated surgically during 18 years at one institution. Postoperative angiography was performed in 81% of the cases. Clinical grading using the Glasgow Outcome Scale was conducted at the time of hospital discharge and for 91% of the surviving patients at 6 months after surgery. The preoperative parameters that were linked statistically to poor clinical outcome were identified through the use of single and multivariate analyses.
RESULTS
More than 80% of the patients were operated on using some modification of the trans-sylvian exposure, and temporary arterial occlusion was used routinely. Good outcomes (Glasgow Outcome Scale scores of 4 or 5) were achieved in 76% of the patients at the time of discharge and in 81% of the patients at 6 months after surgery. There was no incidence of postoperative subarachnoid hemorrhage. Residual aneurysm was revealed by postoperative angiography in 6% of the cases. Factors found to be statistically linked to poor outcome included poor admission grade (Hunt and Hess Grades IV and V), patient age older than 65 years, computed tomographic demonstration of thick basal cistern clot, aneurysm size greater than 20 mm, and symptoms attributable to brain stem compression.
CONCLUSION
Direct microsurgical repair of basilar apex aneurysms should result in good clinical outcomes in 80 to 85% of cases, with reliable prevention of subarachnoid bleeding and routine elimination/reduction of symptoms secondary to mass effect. Those patients who are at high risk for poor outcomes can be identified by the presence of certain clinical, radiographic, and demographic features before undergoing surgery and can be considered for alternative or adjunctive modes of therapy if long-term efficacy of such treatment is demonstrated.
影响因子：
4.1
作者：
GUGLIELMI, G;VINUELA, F;SEPETKA, I
通讯作者：
SEPETKA, I