Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2012 Sep;75(9):454-8. doi: 10.1016/j.jcma.2012.06.016. Epub 2012 Aug 18.
We evaluated adverse ischemic events as early surgical results of microsurgical clipping of 44 and 34 posterior communicating artery (PComA) aneurysms through the pterional transsylvian and pretemporal transclinoidal approach, respectively, between January 2007 and October 2010.
Patients undergoing PComA aneurysm clipping were divided into two groups, and their immediate surgical results were compared and analyzed. Those who underwent the pterional transsylvian approach (group A) comprised 42 patients with 44 PComA aneurysms (24 ruptured and 20 unruptured). Those who underwent the pretemporal transclinoidal approach (group B) comprised 32 patients with 34 PComA aneurysms (20 ruptured and 14 unruptured).
The immediate postoperative total occlusion rates were 97.7% in group A and 100% in group B. The pretemporal transclinoidal approach significantly reduced the overall risk of silent and symptomatic ischemic strokes (p = 0.04) in ruptured PComA clippings and tended to lower the incidence of intraoperative aneurysm rupture (p = 0.07) as well as the overall ischemic events (p = 0.06) in a total of 78 aneurysm clippings, as compared with the pterional transsylvian approach. Although not significantly, the pretemporal transclinoidal approach also tended to have a lower incidence of intraoperative aneurysm rupture in ruptured aneurysm clippings (p = 0.11), which were mainly responsible for the symptomatic ischemia. The pretemporal transclinoidal approach had no additional advantage over the traditional pterional transsylvian approach in unruptured PComA aneurysm clippings in the present study.
The pretemporal transclinoidal approach achieved better visualization of the vital neurovascular structures surrounding PComA aneurysms, which might be a key improvement in lowering the risk of intraoperative aneurysm rupture and obtaining significantly satisfactory immediate surgical results in the microsurgical clipping of PComA aneurysms, especially ruptured ones.
我们评估了 2007 年 1 月至 2010 年 10 月期间，分别通过翼点经外侧裂和颞前经蝶入路显微夹闭的 44 例和 34 例后交通动脉（PComA）动脉瘤的不良缺血性事件作为早期手术结果。
将接受 PComA 动脉瘤夹闭的患者分为两组，并对其即刻手术结果进行比较和分析。经翼点经外侧裂入路（A 组）的患者有 42 例，共 44 个 PComA 动脉瘤（24 个破裂，20 个未破裂）。经颞前经蝶入路（B 组）的患者有 32 例，共 34 个 PComA 动脉瘤（20 个破裂，14 个未破裂）。
A 组术后即刻完全闭塞率为 97.7%，B 组为 100%。颞前经蝶入路显著降低了破裂 PComA 夹闭的无症状和有症状缺血性卒中的总体风险（p=0.04），并且在总共 78 个动脉瘤夹闭中，也有降低术中动脉瘤破裂的趋势（p=0.07）和缺血性事件的总体发生率（p=0.06）。虽然不显著，但颞前经蝶入路在破裂动脉瘤夹闭中也有降低术中动脉瘤破裂的趋势（p=0.11），这主要是导致有症状缺血的原因。在本研究中，对于未破裂的 PComA 动脉瘤夹闭，颞前经蝶入路与传统的翼点经外侧裂入路相比没有额外的优势。
颞前经蝶入路对 PComA 动脉瘤周围的重要神经血管结构具有更好的可视化效果，这可能是降低术中动脉瘤破裂风险和获得 PComA 动脉瘤显微夹闭的显著满意即刻手术结果的关键改进，特别是对于破裂的动脉瘤。
