Liu Yaoling, Shi Xiangen, Kc K I Singh, Sun Yuming, Liu Fangjun, Qian Hai, Zhang Jie
Department of Neurosurgery, Affiliated Fuxing Hospital, Capital Medical University, Beijing.
Department of Neurosurgery, Affiliated Fuxing Hospital, Capital Medical University, Beijing; Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing.
World Neurosurg. 2018 Mar;111:e710-e721. doi: 10.1016/j.wneu.2017.12.158. Epub 2018 Jan 6.
There has been a massive shift in the balance toward endovascular therapy for basilar artery (BA) aneurysms in the modern era.
We retrospectively reviewed clinical and radiologic data from patients with BA aneurysms who were treated in a single medical center during a 10-year period from August 2006 to May 2016.
Thirty-five consecutive patients with 46 aneurysms during the 10-year period were included. The rate of complete aneurysm occlusion in 35 cases using a 1-stage operation was 58.8% (20/34). The graft patency rates of 13 bypass surgeries were 84.6% (11/13) within 1 week and 69.2% (9/13) at 3 months after surgery. The cut flow index for all bypass cases was 0.79. The overall survival was 94% at discharge (2 patients died). The 3-month outcome was favorable (modified Rankin Scale score 0-2) for 27 patients (77.1%) and poor (modified Rankin Scale score 3-5) for 5 patients (14.2%), and 3 patients died (8.6%). The survival for patients with BA apex aneurysms was higher than the survival observed for patients with BA trunk/vertebrobasilar junction aneurysms.
Microsurgical treatments for BA aneurysms can be effective, with good patient outcomes in the early stage after operation. Patients with wide-necked, fusiform, or dolichoectatic aneurysms seem to exclude the aneurysm, preventing unnecessary retreatments with bypass techniques. The potential for a poor prognosis of patients with BA trunk/vertebrobasilar junction aneurysms was higher than that for patients with basilar apex aneurysms who presented with unfavorable subsequent events.
在现代，基底动脉（BA）动脉瘤的治疗平衡已大幅转向血管内治疗。
我们回顾性分析了2006年8月至2016年5月这10年间在单一医疗中心接受治疗的BA动脉瘤患者的临床和放射学数据。
这10年间连续纳入了35例患者的46个动脉瘤。35例采用一期手术的患者中，动脉瘤完全闭塞率为58.8%（20/34）。13例搭桥手术患者的移植物通畅率在术后1周时为84.6%（11/13），术后3个月时为69.2%（9/13）。所有搭桥病例的分流指数为0.79。出院时总体生存率为94%（2例患者死亡）。27例患者（77.1%）3个月时预后良好（改良Rankin量表评分为0 - 2分），5例患者（14.2%）预后较差（改良Rankin量表评分为3 - 5分），3例患者死亡（8.6%）。BA尖部动脉瘤患者的生存率高于BA主干/椎基底动脉交界处动脉瘤患者的生存率。
BA动脉瘤的显微外科治疗可能有效，术后早期患者预后良好。宽颈、梭形或迂曲扩张型动脉瘤患者似乎可排除动脉瘤，避免使用搭桥技术进行不必要的再次治疗。BA主干/椎基底动脉交界处动脉瘤患者预后不良的可能性高于出现不良后续事件的BA尖部动脉瘤患者。
