Bohnstedt Bradley N, Conger Andrew R, Edwards John, Ziemba-Davis Mary, Edwards Gary, Brom Jacqueline, Shah Kushal, Cohen-Gadol Aaron A
Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA.
Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA.
World Neurosurg. 2019 Feb;122:e896-e906. doi: 10.1016/j.wneu.2018.10.172. Epub 2018 Nov 4.
Anterior communicating artery (ACoA) complex aneurysms are challenging to treat microsurgically. The authors report their experience with microsurgical treatment of ACoA aneurysms and examine the anatomic characteristics of these aneurysms as predictors of outcome.
The authors queried their institution's aneurysm database for records of consecutive patients treated for ACoA aneurysms via microsurgical clip ligation. Data included patient demographics and clinical/radiographic presentation characteristics as well as operative techniques. Glasgow Outcome Scale (GOS) scores at hospital discharge and 6-month as well as 1-year follow-up were analyzed.
Of 319 ACoA aneurysms that underwent treatment, 259 were ruptured and 60 were unruptured. Average GOS at 1-year follow-up for all patients was 4.6. Average GOS for patients with ruptured aneurysms correlated with Hunt and Hess grade at presentation, presence of frontal hemorrhages, and need for multiple clips during surgery. Notably, 142 (44.5%) of aneurysms originated mainly from the ACoA artery; 12 (3.8%) primarily from the A1 branch; 3 (0.9%) from the A2 branch; and 162 (50.8%) from the A1/A2 junction. Aneurysm projection was superior in 118 (37%), inferior in 106 (33.2%), anterior in 88 (27.6%), and posterior in 7 (2.2%). Patients with aneurysms originating from the A1 segment had worse outcomes. Posteriorly projecting aneurysms were more likely to be unruptured and larger than other aneurysm configurations.
The aneurysm's exact location in relation to the adjacent neurovascular structures is potentially predictive of outcomes in the microsurgical treatment of ACoA aneurysms.
前交通动脉（ACoA）复合体动脉瘤的显微手术治疗具有挑战性。作者报告他们显微手术治疗ACoA动脉瘤的经验，并研究这些动脉瘤的解剖特征作为预后预测指标。
作者查询了其所在机构的动脉瘤数据库，以获取通过显微手术夹闭治疗ACoA动脉瘤的连续患者记录。数据包括患者人口统计学和临床/影像学表现特征以及手术技术。分析了出院时、6个月以及1年随访时的格拉斯哥预后量表（GOS）评分。
在接受治疗的319例ACoA动脉瘤中，259例为破裂型，60例为未破裂型。所有患者1年随访时的平均GOS为4.6。破裂动脉瘤患者的平均GOS与就诊时的Hunt和Hess分级、额叶出血的存在以及手术中需要多个夹子相关。值得注意的是，142例（44.5%）动脉瘤主要起源于ACoA动脉；12例（3.8%）主要起源于A1分支；3例（0.9%）起源于A2分支；162例（50.8%）起源于A1/A2交界处。动脉瘤的投影方向为向上118例（37%）、向下106例（33.2%）、向前88例（27.6%）、向后7例（2.2%）。起源于A1段的动脉瘤患者预后较差。向后投影的动脉瘤比其他动脉瘤形态更可能未破裂且更大。
动脉瘤相对于相邻神经血管结构的确切位置可能是ACoA动脉瘤显微手术治疗预后的预测指标。
