Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA.
Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA.
World Neurosurg. 2014 Jul-Aug;82(1-2):118-29. doi: 10.1016/j.wneu.2013.06.016. Epub 2013 Jul 9.
Basilar artery apex aneurysms continue to generate technical challenges and management controversy. Endovascular intervention is becoming the mainstay in the management of these formidable aneurysms, but it has limitations, especially with large/giant or wide neck basilar apex aneurysms. There is paucity of data in the available literature pertaining to the successful management of large/giant, wide neck, and calcified/thrombosed basilar apex aneurysms. We present our experience with consecutively operated complex basilar apex aneurysms so as to present the role of microneurosurgery as a viable management option for these aneurysms.
Ours is a retrospective analysis of case-records for operated cases of basilar artery aneurysms spanning 18 years. Basilar apex aneurysms >10 cm, calcified or thrombosed, neck ≥4 mm posterior direction, and retro/subsellar were considered as complex anatomy aneurysms. Basilar apex aneurysms with favorable anatomy were included in the study as a reference group for statistical analysis. Patient demographics, complex features of aneurysms, clinical grade, and outcomes were analyzed.
A total of 33 (53.2%) patients had complex anatomy: large (>10 mm) in eight (24.2%); giant aneurysms (>25 mm) in seven (21.2%); wide-neck in 22 (66.7%); and calcified/thrombosed morphology in five (15.1%). The mean age was 48.5 years, and 22 (66.67%) were women. All aneurysms were clipped by the use of various skull base approaches. A total of 71.9% of patients harboring complex aneurysm had good outcomes. If only unruptured and good grade complex aneurysms also are considered, then 86.9% (n = 20) patients had good outcomes. Statistically there was no significant difference in the outcomes of complex and noncomplex aneurysm.
Although concerning, the management of large/giant, wide neck, and calcified/thrombosed aneurysms with microneurosurgery is still a competitive alternative to endovascular therapy. After careful selection of appropriate skull base approaches based on the complexity of the basilar apex aneurysm, microneurosurgery can achieve acceptable results.
基底动脉尖动脉瘤仍然存在技术挑战和治疗争议。血管内介入治疗已成为这些棘手动脉瘤治疗的主要方法，但存在局限性，尤其是对于大/巨大或宽颈基底动脉尖动脉瘤。现有文献中关于大/巨大、宽颈、钙化/血栓形成的基底动脉尖动脉瘤的成功治疗的数据很少。我们介绍了连续手术治疗复杂基底动脉尖动脉瘤的经验，以展示显微神经外科作为这些动脉瘤的可行治疗选择的作用。
这是一项回顾性分析，纳入了 18 年来接受手术治疗的基底动脉动脉瘤病例。基底动脉尖动脉瘤>10cm，钙化或血栓形成，颈≥4mm 后向，且位于视交叉后或鞍上被认为是复杂解剖动脉瘤。基底动脉尖动脉瘤的解剖结构良好，也被纳入研究作为统计分析的参考组。分析患者的人口统计学、动脉瘤的复杂特征、临床分级和结果。
共有 33 例（53.2%）患者具有复杂的解剖结构：8 例（24.2%）为大型（>10mm）；7 例（21.2%）为巨大动脉瘤（>25mm）；22 例（66.7%）为宽颈；5 例（15.1%）为钙化/血栓形成。平均年龄为 48.5 岁，22 例（66.67%）为女性。所有动脉瘤均采用各种颅底入路夹闭。71.9%的复杂动脉瘤患者预后良好。如果仅考虑未破裂和良好分级的复杂动脉瘤，那么 86.9%（n=20）患者预后良好。在统计学上，复杂和非复杂动脉瘤的治疗效果没有显著差异。
尽管存在担忧，但对于大型/巨大、宽颈、钙化/血栓形成的动脉瘤，采用显微神经外科治疗仍然是血管内治疗的一种有竞争力的替代方法。根据基底动脉尖动脉瘤的复杂性，仔细选择合适的颅底入路后，显微神经外科可以取得可接受的结果。
