Brown Benjamin L, Lopes Demetrius, Miller David A, Tawk Rabih G, Brasiliense Leonardo B C, Ringer Andrew, Sauvageau Eric, Powers Ciarán J, Arthur Adam, Hoit Daniel, Snyder Kenneth, Siddiqui Adnan, Levy Elad, Hopkins L Nelson, Cuellar Hugo, Rodriguez-Mercado Rafael, Veznedaroglu Erol, Binning Mandy, Mocco J, Aguilar-Salinas Pedro, Boulos Alan, Yamamoto Junichi, Hanel Ricardo A
Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida;
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;
J Neurosurg. 2016 Apr;124(4):1107-13. doi: 10.3171/2015.4.JNS142790. Epub 2015 Oct 16.
The authors sought to determine whether flow diversion with the Pipeline Embolization Device (PED) can approximate microsurgical decompression in restoring function after cranial neuropathy following carotid artery aneurysms.
This multiinstitutional retrospective study involved 45 patients treated with PED across the United States. All patients included presented between November 2009 and October 2013 with cranial neuropathy (cranial nerves [CNs] II, III, IV, and VI) due to intracranial aneurysm. Outcome analysis included clinical and procedural variables at the time of treatment as well as at the latest clinical and radiographic follow-up.
Twenty-six aneurysms (57.8%) were located in the cavernous segment, while 6 (13.3%) were in the clinoid segment, and 13 (28.9%) were in the ophthalmic segment of the internal carotid artery. The average aneurysm size was 18.6 mm (range 4-35 mm), and the average number of flow diverters placed per patient was 1.2. Thirty-eight patients had available information regarding duration of cranial neuropathy prior to treatment. Eleven patients (28.9%) were treated within 1 month of symptom onset, while 27 (71.1%) were treated after 1 month of symptoms. The overall rate of cranial neuropathy improvement for all patients was 66.7%. The CN deficits resolved in 19 patients (42.2%), improved in 11 (24.4%), were unchanged in 14 (31.1%), and worsened in 1 (2.2%). Overtime, the rate of cranial neuropathy improvement was 33.3% (15/45), 68.8% (22/32), and 81.0% (17/21) at less than 6, 6, and 12 months, respectively. At last follow-up, 60% of patients in the isolated CN II group had improvement, while in the CN III, IV, or VI group, 85.7% had improved. Moreover, 100% (11/11) of patients experienced improvement if they were treated within 1 month of symptom onset, whereas 44.4% (12/27) experienced improvement if they treated after 1 month of symptom onset; 70.4% (19/27) of those with partial deficits improved compared with 30% (3/10) of those with complete deficits.
Cranial neuropathy caused by cerebral aneurysm responds similarly when the aneurysm is treated with the PED compared with open surgery and coil embolization. Lower morbidity and higher occlusion rates obtained with the PED may suggest it as treatment of choice for some of these lesions. Time to treatment is an important consideration regardless of treatment modality.
作者旨在确定使用Pipeline栓塞装置（PED）进行血流导向是否能在颈动脉动脉瘤导致颅神经病变后恢复功能方面近似显微外科减压术。
这项多机构回顾性研究纳入了美国45例接受PED治疗的患者。所有纳入患者在2009年11月至2013年10月期间因颅内动脉瘤出现颅神经病变（第II、III、IV和VI颅神经）。结果分析包括治疗时以及最新临床和影像学随访时的临床和手术变量。
26个动脉瘤（57.8%）位于海绵窦段，6个（13.3%）位于床突段，13个（28.9%）位于颈内动脉眼段。动脉瘤平均大小为18.6毫米（范围4 - 35毫米），每位患者放置的血流导向装置平均数量为1.2个。38例患者有治疗前颅神经病变持续时间的可用信息。11例患者（28.9%）在症状发作1个月内接受治疗，27例（71.1%）在症状发作1个月后接受治疗。所有患者颅神经病变改善的总体率为66.7%。19例患者（42.2%）的颅神经功能缺损消失，11例（24.4%）改善，14例（31.1%）无变化，1例（2.2%）恶化。随着时间推移，颅神经病变改善率在少于6个月、6个月和12个月时分别为33.3%（15/45）、68.8%（22/32）和81.0%（17/21）。在最后随访时，孤立性第II颅神经组60%的患者有改善，而在第III、IV或VI颅神经组，85.7%的患者有改善。此外，100%（11/11）的患者如果在症状发作1个月内接受治疗则有改善，而如果在症状发作1个月后接受治疗则44.4%（12/27）有改善；部分功能缺损患者中有70.4%（19/27）改善，而完全功能缺损患者中有30%（3/10）改善。
与开放手术和弹簧圈栓塞相比，用PED治疗脑动脉瘤引起的颅神经病变反应相似。PED具有较低的发病率和较高的闭塞率，这可能表明它是这些病变中某些病变的首选治疗方法。无论采用何种治疗方式，治疗时机都是一个重要的考虑因素。
