de Araújo Júnior Antônio Santos, de Aguiar Paulo Henrique Pires, Fazzito Mirella Martins, Simm Renata, Stefani Marco Antonio, Zicarelli Carlos Alexandre, Antunes Apio Claudio
Division of Post Graduation in Surgery, Federal University of Rio Grande do Sul, Porto Alegre, Brazil,
Acta Neurochir Suppl. 2015;120:231-5. doi: 10.1007/978-3-319-04981-6_39.
This study was undertaken to determine variables that could predict, in the perioperative period of anterior communicating artery (ACom) aneurysms surgeries, the likelihood of postoperative sequelae and complications, after temporary arterial occlusion (TAO).
In a universe of 32 patients submitted to ACom aneurysm repair in the last 7 years, 21 needed TAO intraoperatively, and had their data examined retrospectively.
Aneurysms larger than 7 mm were more likely to be treated with longer TAO time than small aneurysms, (p < 0.0001). There was no statistical correlation between time of occlusion and outcome. Age, Glasgow Coma Scale at initial evaluation, and Fisher scale at first CT scanning were independent factors of unfavorable outcome (p < 0.001). Meanwhile gender, tobacco addiction, obesity, arterial hypertension, dyslipidemia, location of TAO (A1 or A2), intraoperative rupture (IR) and the aneurysm size were not identified as independent prognostic factors.During follow-up period, two thirds of the patients had a favorable outcome, accomplishing normal daily life activities without major complications. Most patients developed clinical vasospasm (66.6 %), with 19 % of the patients harboring a severe disease. Delayed ischemic neurological deficit was observed in 28.5 %, without any statistical correlation to time of TAO or IR.
TAO during ACom aneurysm repair does not seem to add more morbidities to the procedure, and is not an independent prognostic factor.
本研究旨在确定在前交通动脉（ACom）动脉瘤手术围手术期，临时动脉闭塞（TAO）后可预测术后后遗症和并发症可能性的变量。
在过去7年中接受ACom动脉瘤修复的32例患者中，21例术中需要TAO，并对他们的数据进行回顾性检查。
大于7mm的动脉瘤比小动脉瘤更有可能接受更长时间的TAO治疗（p<0.0001）。闭塞时间与预后之间无统计学相关性。年龄、初始评估时的格拉斯哥昏迷量表评分以及首次CT扫描时的Fisher量表评分是不良预后的独立因素（p<0.001）。同时，性别、吸烟成瘾、肥胖、动脉高血压、血脂异常、TAO的位置（A1或A2）、术中破裂（IR）以及动脉瘤大小未被确定为独立的预后因素。在随访期间，三分之二的患者预后良好，能够完成日常生活活动且无重大并发症。大多数患者发生临床血管痉挛（66.6%），其中19%的患者病情严重。28.5%的患者出现延迟性缺血性神经功能缺损，与TAO时间或IR无任何统计学相关性。
ACom动脉瘤修复术中的TAO似乎不会给手术增加更多的发病率，且不是一个独立的预后因素。
