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梭形动脉瘤:从发病机制到治疗选择的综述

Fusiform aneurysms: A review from its pathogenesis to treatment options.

作者信息

Barletta Enrico Affonso, Ricci Renato Lazarin, Silva Renato Di Gugliemo, Gaspar Ranieri Henrique Moraes Lopes, Araújo João Flávio Mattos, Neves Maick Willen Fernandes, de Aquino José Luis Braga, Barba Belsuzarri Telmo Augusto

机构信息

Medicine Student from Pontifical Catholic University of Campinas, Brazil.

Department of Neurosurgery from Pontifical Catholic University of Campinas, Brazil.

出版信息

Surg Neurol Int. 2018 Sep 20;9:189. doi: 10.4103/sni.sni_133_18. eCollection 2018.

Abstract

BACKGROUND

This study aims to present the most important considerations when it comes to patients features, clinical presentation, localization, and morphology of the aneurysm and the treatments outcomes of the fusiform aneurysms.

METHODS

We performed a literature review using PubMed. The search was limited to the studies published in English, from 2003 to 2017.

RESULTS

The studies analyzed that showed data about the patient features, clinical presentation, the aneurysm localization, morphology, and pathogenesis didn't present much divergence. The surgical and the endovascular approach showed similar treatments outcomes. The reconstructive techniques seem to be safer than the deconstructive. The flow diversion is a technique that showed great results.

CONCLUSION

Most of the patients are men, younger than 50 years old, pediatric patients are the most affected. Surgical procedures still have an important place in this field. Reconstructive and deconstructive techniques are both effective; the reconstructive techniques are possibly safer than deconstructive techniques. The most important feature of an aneurysm to predict a bad prognose is to determine if the aneurysm is ruptured. The reconstructive EVT accompanied by dual antiplatelet after and before the procedure showed the best results to treat the basilar fusiform aneurysms. Deconstructive treatment including posterior inferior cerebellar artery occlusion should be considered.

摘要

背景

本研究旨在阐述在患者特征、临床表现、动脉瘤的位置及形态以及梭形动脉瘤的治疗结果等方面最重要的考量因素。

方法

我们使用PubMed进行了文献综述。检索限于2003年至2017年以英文发表的研究。

结果

所分析的研究显示,关于患者特征、临床表现、动脉瘤位置、形态及发病机制的数据差异不大。手术和血管内治疗方法显示出相似的治疗结果。重建技术似乎比解构技术更安全。血流导向是一种效果显著的技术。

结论

大多数患者为男性,年龄小于50岁,儿童患者受影响最大。手术在该领域仍占有重要地位。重建技术和解构技术均有效;重建技术可能比解构技术更安全。预测预后不良的动脉瘤最重要特征是确定动脉瘤是否破裂。术前和术后使用双重抗血小板药物的重建性血管内治疗在治疗基底动脉梭形动脉瘤方面显示出最佳效果。应考虑包括小脑后下动脉闭塞在内的解构性治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a63e/6169346/8ef6f715e766/SNI-9-189-g001.jpg

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