巨大海绵窦颈动脉瘤中的颅神经缺损及其与动脉瘤形态和位置的关系。
Cranial nerve deficits in giant cavernous carotid aneurysms and their relation to aneurysm morphology and location.
机构信息
Department of Neurosurgery, Bezirkskrankenhaus Günzburg, University of Ulm, Günzburg, Germany.
Department of Neuroradiology, Metropolitan Hospital Niguarda, Milan, Italy.
出版信息
Acta Neurochir (Wien). 2018 Aug;160(8):1653-1660. doi: 10.1007/s00701-018-3580-2. Epub 2018 Jun 9.
BACKGROUND
Giant cavernous carotid aneurysms (GCCAs) usually exert substantial mass effect on adjacent intracavernous cranial nerves. Since predictors of cranial nerve deficits (CNDs) in patients with GCCA are unknown, we designed a study to identify associations between CND and GCCA morphology and the location of mass effect.
METHODS
This study was based on data from the prospective clinical and imaging databases of the Giant Intracranial Aneurysm Registry. We used magnetic resonance imaging and digital subtraction angiography to examine GCCA volume, presence of partial thrombosis (PT), GCCA origins, and the location of mass effect. We also documented whether CND was present.
RESULTS
We included 36 GCCA in 34 patients, which had been entered into the registry by eight participating centers between January 2009 and March 2016. The prevalence of CND was 69.4%, with one CND in 41.7% and more than one in 27.5%. The prevalence of PT was 33.3%. The aneurysm origin was most frequently located at the anterior genu (52.8%). The prevalence of CND did not differ between aneurysm origins (p = 0.29). Intracavernous mass effect was lateral in 58.3%, mixed medial/lateral in 27.8%, and purely medial in 13.9%. CND occurred significantly more often in GCCA with lateral (81.0%) or mixed medial/lateral (70.0%) mass effect than in GCCA with medial mass effect (20.0%; p = 0.03). After adjusting our data for the effects of the location of mass effect, we found no association between the prevalence of CND and aneurysm volume (odds ratio (OR) 1.30 (0.98-1.71); p = 0.07), the occurrence of PT (OR 0.64 (0.07-5.73); p = 0.69), or patient age (OR 1.02 (95% CI 0.95-1.09); p = 0.59).
CONCLUSIONS
Distinguishing between medial versus lateral location of mass effect may be more helpful than measuring aneurysm volumes or examining aneurysm thrombosis in understanding why some patients with GCCA present with CND while others do not.
CLINICAL TRIAL REGISTRATION NO
NCT02066493 ( clinicaltrials.gov ).
背景
巨大海绵窦颈动脉瘤（GCCAs）通常对邻近海绵窦颅神经产生显著的占位效应。由于预测 GCCA 患者颅神经缺损（CND）的因素未知，我们设计了一项研究来确定 CND 与 GCCA 形态和占位效应位置之间的关联。
方法
本研究基于前瞻性临床和影像学数据库的巨颅内动脉瘤登记处的数据。我们使用磁共振成像和数字减影血管造影来检查 GCCA 体积、部分血栓形成（PT）、GCCA 起源和占位效应的位置。我们还记录了是否存在 CND。
结果
我们纳入了 2009 年 1 月至 2016 年 3 月期间 8 个参与中心登记的 36 个 GCCA 患者。CND 的患病率为 69.4%，41.7%的患者存在单一 CND，27.5%的患者存在多个 CND。PT 的患病率为 33.3%。动脉瘤起源最常见于前关节（52.8%）。动脉瘤起源处的 CND 患病率无差异（p=0.29）。海绵窦内占位效应呈外侧者占 58.3%，混合性内侧/外侧者占 27.8%，单纯内侧者占 13.9%。GCCA 出现外侧（81.0%）或混合性内侧/外侧（70.0%）占位效应时，CND 的发生率明显高于出现内侧占位效应（20.0%；p=0.03）。在对数据进行了占位效应位置影响的调整后，我们发现 CND 的患病率与动脉瘤体积（比值比（OR）1.30（95%CI 0.98-1.71）；p=0.07）、PT 的发生（OR 0.64（0.07-5.73）；p=0.69）或患者年龄（OR 1.02（95%CI 0.95-1.09）；p=0.59）之间无关联。
结论
区分占位效应的内侧与外侧位置可能比测量动脉瘤体积或检查动脉瘤血栓形成更有助于理解为什么一些 GCCA 患者出现 CND，而另一些患者则没有。
临床试验注册号
NCT02066493（clinicaltrials.gov）。
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