颅内破裂动脉瘤手术夹闭后的早期再治疗

Early retreatment after surgical clipping of ruptured intracranial aneurysms.

作者信息

Ito Yoshiro, Yamamoto Tetsuya, Ikeda Go, Tsuruta Wataro, Uemura Kazuya, Komatsu Yoji, Matsumura Akira

机构信息

Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Ten-nodai, Tsukuba, Ibaraki, 305-8575, Japan.

Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan.

出版信息

Acta Neurochir (Wien). 2017 Sep;159(9):1627-1632. doi: 10.1007/s00701-017-3245-6. Epub 2017 Jun 23.

DOI:10.1007/s00701-017-3245-6

PMID:28646464

Abstract

BACKGROUND

Although a rerupture after surgical clipping of ruptured intracranial aneurysms is rare, it is associated with high morbidity and mortality. The causes for retreatment and rupture after surgical clipping are not clearly defined.

METHODS

From a prospectively maintained database of 244 patients who had undergone surgical clipping of ruptured intracranial aneurysms, we selected patients who experienced retreatment or rerupture within 30 days after surgical clipping. Aneurysm occlusions were examined by microvascular Doppler ultrasonography and indocyanine green video-angiography. Indications for retreatment included rerupture and partial occlusion. We analyzed the characteristics and causes of early retreatment.

RESULTS

Six patients (2.5%, 95% CI 0.9 to 5.3%) were retreated within 30 days after surgical clipping, including two patients (0.8%, 95% CI 0.1 to 2.9%) who experienced a rerupture. The retreated aneurysms were found in the anterior communicating artery (AcomA) (n = 5) and basilar artery (n = 1). Retreatment of the AcomA (7.5%) was performed significantly more frequently than that of other arteries (0.56%) (p < 0.01). A laterally projected AcomA aneurysm (17.4%) was more frequently retreated than were other aneurysm types (2.3%). Cases of laterally projecting AcomA aneurysms tended to result from an incomplete clip placed using a pterional approach from the opposite side of the aneurysm projection.

CONCLUSIONS

Despite developments, the rates of retreatment and rerupture after surgical clipping remain similar to those reported previously. Retreatment of the AcomA was significantly more frequent than was retreatment of other arteries. Patients underwent retreatment more frequently when they were originally treated for lateral type aneurysms using a pterional approach from the opposite side of the aneurysm projection. The treatment method and evaluation modalities should be considered carefully for AcomA aneurysms in particular.

摘要

背景

尽管颅内破裂动脉瘤手术夹闭后再破裂很少见，但它与高发病率和死亡率相关。手术夹闭后再次治疗及破裂的原因尚未明确界定。

方法

从一个前瞻性维护的244例颅内破裂动脉瘤手术夹闭患者的数据库中，我们选择了在手术夹闭后30天内经历再次治疗或再破裂的患者。通过微血管多普勒超声和吲哚菁绿视频血管造影检查动脉瘤闭塞情况。再次治疗的指征包括再破裂和部分闭塞。我们分析了早期再次治疗的特征和原因。

结果

6例患者（2.5%，95%可信区间0.9%至5.3%）在手术夹闭后30天内接受了再次治疗，其中2例患者（0.8%，95%可信区间0.1%至2.9%）发生了再破裂。再次治疗的动脉瘤位于前交通动脉（AcomA）（n = 5）和基底动脉（n = 1）。AcomA的再次治疗（7.5%）显著比其他动脉（0.56%）更频繁（p < 0.01）。向外侧突出的AcomA动脉瘤（17.4%）比其他动脉瘤类型（2.3%）更频繁地接受再次治疗。向外侧突出的AcomA动脉瘤病例往往是由于从动脉瘤投影对侧采用翼点入路放置的夹子不完全所致。