Impact of subcallosal artery origin and A1 asymmetry on surgical outcomes of anterior communicating artery aneurysms
Impact of subcallosal artery origin and A1 asymmetry on surgical outcomes of anterior communicating artery aneurysms
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胼胝下动脉起源和A1不对称对前交通动脉瘤手术效果的影响
DOI：
10.1007/s00701-021-04979-w
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发表时间：
2021
影响因子：
2.4
通讯作者：
Ueba Tetsuya
中科院分区：
文献类型：
--
作者：
Fukuda Hitoshi;Hamada Fumihiro;Nonaka Motonobu;Ueba Yusuke;Fukui Naoki;Kurosaki Yoshitaka;Morioka Jun;Koyanagi Masaomi;Nakajima Norio;Uezato Minami;Yasuda Takaya;Chin Masaki;Yamagata Sen;Murao Kenichi;Yamada Keisuke;Ohta Tsuyoshi;Lo Benjamin;Ueba Tetsuya
背景前交通动脉瘤由于其复杂的解剖结构，手术夹闭仍然具有挑战性。前交通动脉瘤手术的解剖学风险因素需要进一步阐明。本研究的目的是调查是否接近中线穿通动脉，胼胝体下动脉（SubCA），以及相关的异常的ACoA复杂的影响功能的ACoA动脉瘤surgery.MethodsA共92例未破裂和破裂的ACoA动脉瘤，谁接受手术夹闭，从一个多中心，观察队列数据库进行了回顾性分析。在纵裂入路亚组（n= 56）中，分析了显微手术观察下前交通动脉解剖结构与小脑延髓颈CA下动脉起源的相关性。然后，我们评估了是否与SubCA颈部起源相关的解剖因素影响手术结果在整个队列（纵裂和翼点入路，n= 92）。ResultsIn纵裂入路队列，A1不对称和动脉瘤大小≥ 5.0 mm的组合分层的SubCA颈部起源的概率最高的决策树分析。然后，通过多变量logistic回归分析，在采用纵裂入路或翼点入路的整个队列中，A1不对称和椎弓根直径≥ 5.0 mm的组合与不良功能结局显著相关（OR 6.76; 95% CI 1.19-38.5; p= 0.03）的平均值结论A1不对称和较大的蛛网膜下腔大小与SubCA显著相关前交通动脉瘤手术中的瘤颈起源和不良功能结局。建议采用纵裂入路，为具有这种高风险解剖变异的前交通动脉瘤提供更宽和更通畅的SubCA视野。
BackgroundSurgical clipping of anterior communicating artery (ACoA) aneurysms remains challenging due to their complex anatomy. Anatomical risk factors for ACoA aneurysm surgery require further elucidation. The aim of this study is to investigate whether proximity of the midline perforating artery, subcallosal artery (SubCA), and associated anomaly of the ACoA complex affect functional outcomes of ACoA aneurysm surgery.MethodsA total of 92 patients with both unruptured and ruptured ACoA aneurysms, who underwent surgical clipping, were retrospectively analyzed from a multicenter, observational cohort database. Association of ACoA anatomy with SubCA origin at the aneurysmal neck under microsurgical observation was analyzed in the interhemispheric approach subgroup (n= 56). Then, we evaluated whether anatomical factors associated with SubCA neck origin affected surgical outcomes in the entire cohort (both interhemispheric and pterional approaches,n= 92).ResultsIn the interhemispheric approach cohort, combination of A1 asymmetry and aneurysmal size ≥ 5.0 mm was stratified to have the highest probability of the SubCA neck origin by a decision tree analysis. Then, among the entire cohort using either interhemispheric or pterional approach, combination of A1 asymmetry and aneurysmal size ≥ 5.0 mm was significantly associated with poor functional outcomes by multivariable logistic regression analysis (OR 6.76; 95% CI 1.19–38.5;p= 0.03) as compared with A1 symmetry group in the acute subarachnoid hemorrhage settings.ConclusionCombination of A1 asymmetry and larger aneurysmal size was significantly associated with SubCA aneurysmal neck origin and poor functional outcomes in ACoA aneurysm surgery. Interhemispheric approach may be proposed to provide a wider and unobstructed view of SubCA for ACoA aneurysms with this high-risk anatomical variant.
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影响因子：
4.1
作者：
Satomi, Junichiro;Ghaibeh, A. Ammar;Nagahiro, Shinji
通讯作者：
Nagahiro, Shinji
沿基底穿动脉分布的脑梗死的计算机断层扫描。
影响因子：
19.7
作者：
S. Takahashi;K. Goto;H. Fukasawa;Y. Kawata;K. Uemura;K. Suzuki
通讯作者：
K. Suzuki
影响因子：
4.1
作者：
OGAWA, A;SUZUKI, M;YOSHIMOTO, T
通讯作者：
YOSHIMOTO, T
双额纵裂入路治疗前交通动脉瘤。
影响因子：
4.1
作者：
J. Suzuki;K. Mizoi;T. Yoshimoto
通讯作者：
T. Yoshimoto
影响因子：
2
作者：
Bohnstedt, Bradley N.;Conger, Andrew R.;Cohen-Gadol, Aaron A.
通讯作者：
Cohen-Gadol, Aaron A.