Anterior Communicating Artery Complex Aneurysms: Anatomic Characteristics as Predictors of Surgical Outcome in 300 Cases
Anterior Communicating Artery Complex Aneurysms: Anatomic Characteristics as Predictors of Surgical Outcome in 300 Cases
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DOI：
10.1016/j.wneu.2018.10.172
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发表时间：
2019-02-01
影响因子：
2
通讯作者：
Cohen-Gadol, Aaron A.
中科院分区：
文献类型：
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作者：
Bohnstedt, Bradley N.;Conger, Andrew R.;Cohen-Gadol, Aaron A.
目的：前交通动脉（ACoA）复杂动脉瘤的显微手术治疗具有挑战性。作者报告了他们的经验与显微外科手术治疗的ACoA动脉瘤和检查这些动脉瘤的解剖特征作为outcome.METHODS的预测因素：作者查询他们的机构的动脉瘤数据库的记录连续患者治疗的ACoA动脉瘤通过显微手术夹结扎。数据包括患者人口统计学和临床/影像学表现特征以及手术技术。分析出院时和6个月及1年随访时的格拉斯哥预后量表（GOS）评分。结果：在接受治疗的319个前交通动脉瘤中，259个破裂，60个未破裂。所有患者1年随访时的平均GOS为4.6。破裂动脉瘤患者的平均GOS与就诊时的Hunt和Hess分级、是否存在额动脉瘤以及术中是否需要多次夹闭相关。值得注意的是，142例（44.5%）动脉瘤主要起源于前交通动脉; 12例（3.8%）主要起源于A1分支; 3例（0.9%）起源于A2分支; 162例（50.8%）起源于A1/A2交界处。动脉瘤投影上级118例（37%），下部106例（33.2%），前部88例（27.6%），后部7例（2.2%）。动脉瘤起源于A1节段的患者结局较差。后方突出的动脉瘤更有可能是未破裂的，比其他动脉瘤configuration.CONCLUSIONS：动脉瘤的确切位置相对于相邻的神经血管结构是潜在的预测结果的显微手术治疗ACoA动脉瘤。
OBJECTIVE: Anterior communicating artery (ACoA) complex aneurysms are challenging to treat microsurgically. The authors report their experience with microsurgical treatment of ACoA aneurysms and examine the anatomic characteristics of these aneurysms as predictors of outcome.METHODS: The authors queried their institution's aneurysm database for records of consecutive patients treated for ACoA aneurysms via microsurgical clip ligation. Data included patient demographics and clinical/radiographic presentation characteristics as well as operative techniques. Glasgow Outcome Scale (GOS) scores at hospital discharge and 6-month as well as 1-year follow-up were analyzed.RESULTS: Of 319 ACoA aneurysms that underwent treatment, 259 were ruptured and 60 were unruptured. Average GOS at 1-year follow-up for all patients was 4.6. Average GOS for patients with ruptured aneurysms correlated with Hunt and Hess grade at presentation, presence of frontal hemorrhages, and need for multiple clips during surgery. Notably, 142 (44.5%) of aneurysms originated mainly from the ACoA artery; 12 (3.8%) primarily from the A1 branch; 3 (0.9%) from the A2 branch; and 162 (50.8%) from the A1/A2 junction. Aneurysm projection was superior in 118 (37%), inferior in 106 (33.2%), anterior in 88 (27.6%), and posterior in 7 (2.2%). Patients with aneurysms originating from the A1 segment had worse outcomes. Posteriorly projecting aneurysms were more likely to be unruptured and larger than other aneurysm configurations.CONCLUSIONS: The aneurysm's exact location in relation to the adjacent neurovascular structures is potentially predictive of outcomes in the microsurgical treatment of ACoA aneurysms.