Xu Long, Deng Xiaofeng, Wang Shuo, Cao Yong, Zhao Yuanli, Zhang Dong, Zhang Yan, Wang Rong, Qi Wei, Zhao Jizong
Department of Neurosurgery and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
Department of Neurosurgery and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
World Neurosurg. 2017 Jun;102:293-300. doi: 10.1016/j.wneu.2017.03.055. Epub 2017 Mar 22.
To study clinical outcome of giant intracranial aneurysms (diameter ≥25 mm) treated with different surgical modalities and to analyze factors affecting prognosis.
A retrospective analysis was performed of 204 consecutive patients with giant intracranial aneurysms who underwent surgical treatment in our department from 1995 to 2008. Clinical outcome was evaluated with the Glasgow Outcome Scale.
Surgical modalities included direct aneurysm neck clipping in 102 patients (50.0%), parent artery reconstruction in 51 patients (25.0%), proximal artery ligation in 23 patients (11.3%; 4 patients combined with revascularization), trapping in 26 patients (12.7%), and wrapping in 2 patients (1.0%). Follow-up data were available for 181 patients (88.7%), with a mean follow-up period of 62 months (range, 12-164 months). A good outcome (Glasgow Outcome Scale score 5) was observed in 114 patients (63.0%), and a poor outcome (Glasgow Outcome Scale score 1-4) was observed in 67 patients (37.0%). Independent factors that affected prognosis were age and location of aneurysm. Older age (≥50 years) and location of aneurysm in posterior circulation were associated with poor outcome. In 85 patients with preoperative subarachnoid hemorrhage, patients with a higher Hunt and Hess grade (≥3) had a worse outcome compared with patients with a low Hunt and Hess grade (1 or 2). Surgical modalities and other factors were not significantly associated with clinical outcome.
Giant intracranial aneurysms are effectively treated with craniotomy and surgical treatment. Older age, aneurysm location in posterior circulation, and higher Hunt and Hess grade are risk factors affecting prognosis.
研究采用不同手术方式治疗的巨大颅内动脉瘤（直径≥25mm）的临床疗效，并分析影响预后的因素。
对1995年至2008年在我科接受手术治疗的204例连续巨大颅内动脉瘤患者进行回顾性分析。采用格拉斯哥预后量表评估临床疗效。
手术方式包括102例（50.0%）直接夹闭动脉瘤颈、51例（25.0%）重建载瘤动脉、23例（11.3%；4例合并血管重建）近端动脉结扎、26例（12.7%）孤立术以及2例（1.0%）包裹术。181例（88.7%）患者有随访资料，平均随访时间为62个月（范围12 - 164个月）。114例（63.0%）患者预后良好（格拉斯哥预后量表评分为5分），67例（37.0%）患者预后不良（格拉斯哥预后量表评分为1 - 4分）。影响预后的独立因素为年龄和动脉瘤位置。年龄较大（≥50岁）以及动脉瘤位于后循环与预后不良相关。在85例术前有蛛网膜下腔出血的患者中，Hunt和Hess分级较高（≥3级）的患者与分级较低（1或2级）的患者相比，预后更差。手术方式和其他因素与临床疗效无显著相关性。
开颅手术治疗巨大颅内动脉瘤有效。年龄较大、动脉瘤位于后循环以及Hunt和Hess分级较高是影响预后的危险因素。
