Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Neurointerv Surg. 2011 Dec 1;3(4):319-23. doi: 10.1136/jnis.2011.004770. Epub 2011 Mar 1.
Pericallosal, or A2 bifurcation, aneurysms are an infrequently encountered cause of subarachnoid hemorrhage (SAH). While the International Subarachnoid Aneurysm Trial showed improved outcomes for patients with any ruptured anterior circulation aneurysm treated with embolization, there was also a higher recurrence rate for embolized aneurysms. Notably, there were relatively few pericallosal aneurysms.
Specific analysis of pericallosal aneurysms may help guide therapeutic decisions.
Retrospective analysis of patients who presented with proven saccular pericallosal aneurysms was performed at two institutions from 1999 to 2009. Patients were stratified according to presentation Hunt and Hess grades and modified Fisher scores, treatment modality and outcomes as well as development of vasospasm, hydrocephalus and required treatment.
Eighty-eight patients with pericallosal aneurysms were identified. Sixty-two presented with SAH and 26 in elective fashion, 2 of whom had a prior history of SAH. Fifty-four patients underwent microsurgical repair and 32 endovascular repair. Patients presenting with SAH due to pericallosal aneurysm treated with an endovascular approach were more likely to have a good modified Rankin scale (mRS) (mRS 0-2 vs 3-6) (p=0.028), to make a complete recovery (mRS=0) (p=0.017) and were less likely to die (mRS=6) (p=0.026). Patients with electively treated pericallosal aneurysms did not have statistically significant differences in outcome between surgical and endovascular cohorts. Differences in secondary endpoints did not reach significance.
Patients with ruptured pericallosal aneurysms fare better with endovascular therapy, with better chance of complete recovery. Surgical and endovascular treatments of unruptured pericallosal aneurysms have similar results and outcome.
胼周动脉或 A2 分叉部动脉瘤是蛛网膜下腔出血（SAH）的少见病因。虽然国际蛛网膜下腔动脉瘤试验表明，栓塞治疗任何破裂的前循环动脉瘤可改善患者预后，但栓塞后的动脉瘤复发率也更高。值得注意的是，胼周动脉瘤相对较少。
胼周动脉瘤的具体分析可能有助于指导治疗决策。
对 1999 年至 2009 年在两家机构就诊的证实存在囊状胼周动脉瘤的患者进行回顾性分析。根据就诊时的 Hunt 和 Hess 分级以及改良 Fisher 评分、治疗方式和结局以及血管痉挛、脑积水和需要治疗的情况对患者进行分层。
共发现 88 例胼周动脉瘤患者。62 例患者因 SAH 就诊，26 例患者为择期就诊，其中 2 例有既往 SAH 病史。54 例患者接受了显微手术修复，32 例患者接受了血管内治疗。因胼周动脉瘤破裂而行血管内治疗的患者更有可能获得良好的改良 Rankin 量表评分（mRS）（0-2 分与 3-6 分）（p=0.028），更有可能完全康复（mRS=0）（p=0.017），且死亡（mRS=6）的可能性更小（p=0.026）。择期治疗的胼周动脉瘤患者在手术和血管内治疗组之间的结局无统计学差异。次要终点的差异无统计学意义。
破裂的胼周动脉瘤患者行血管内治疗效果更好，完全康复的机会更大。未破裂的胼周动脉瘤的手术和血管内治疗具有相似的结果和结局。
