Dinc Nazife, Lescher Stephanie, Quick-Weller Johanna, Berkefeld Joachim, Platz Johannes, Senft Christian, Seifert Volker, Konczalla Juergen
Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany.
Department of Neuroradiology, Goethe University Hospital, Frankfurt, Germany.
World Neurosurg. 2017 Mar;99:566-571. doi: 10.1016/j.wneu.2016.12.079. Epub 2016 Dec 27.
Pericallosal artery aneurysms (PAAs) are usually rare (2%-5%), and treatment is challenging for both surgical and endovascular modalities. We performed this analysis to determine the outcome and prognostic factors after subarachnoidal hemorrhage (SAH) caused by ruptured PAAs.
A total of 32 patients with ruptured PAA were admitted to our hospital between 1999 and 2014, added to our prospective database, and analyzed retrospectively. Outcome was measured based on the modified Rankin Scale (mRS) at 6 months after ictus (favorable mRS score, 0-2 vs. unfavorable mRS score, 3-6).
Only 16 (50%) patients had a good clinical status at admission (World Federation of Neurological Surgeons Grading System [WFNS] grades I-III), whereas 12 patients (37.5%) were comatose (WFNS grade V). In 18 patients (56%), intracerebral hemorrhage was confirmed, in 18 patients (56%) cerebrospinal fluid drainage was required immediately after admission, and in 5 cases (16%) decompressive craniectomy was performed. There were 17 patients (53.1%) who achieved a favorable outcome (mRS score 0-2) at follow-up. Unfavorable outcome was associated with smoking, cerebral infarction, and worse admission status after multiple logistic regression analysis.
Poor admission status, cerebral infarction, and smoking seem to be crucial factors for unfavorable outcome after SAH from PAA.
胼周动脉瘤（PAA）通常较为罕见（2%-5%），其治疗对手术和血管内治疗方式而言都具有挑战性。我们进行此项分析以确定PAA破裂导致蛛网膜下腔出血（SAH）后的结局及预后因素。
1999年至2014年间，共有32例PAA破裂患者入住我院，纳入我们的前瞻性数据库并进行回顾性分析。结局根据发病后6个月的改良Rankin量表（mRS）进行评估（良好的mRS评分，0-2分与不良的mRS评分，3-6分）。
仅16例（50%）患者入院时临床状态良好（世界神经外科医师联合会分级系统[WFNS]分级I-III级），而12例患者（37.5%）昏迷（WFNS分级V级）。18例患者（56%）确诊有脑出血，18例患者（56%）入院后立即需要脑脊液引流，5例患者（16%）进行了减压性颅骨切除术。17例患者（53.1%）在随访时获得了良好结局（mRS评分0-2分）。经过多因素逻辑回归分析，不良结局与吸烟、脑梗死及较差的入院状态相关。
入院状态差、脑梗死和吸烟似乎是PAA破裂导致SAH后不良结局的关键因素。
