From the Department of Neurosurgery (D.Y.C.), Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Departments of Radiology (B.-S.K.).
AJNR Am J Neuroradiol. 2019 Nov;40(11):1924-1931. doi: 10.3174/ajnr.A6252. Epub 2019 Oct 10.
Unruptured intracranial vertebrobasilar dissecting aneurysms with brain stem compression are difficult to treat. In the present study, the clinical and radiologic outcomes of unruptured intracranial vertebrobasilar dissecting aneurysms with brain stem compression based on different treatment modalities were evaluated.
This study included 28 patients with unruptured intracranial vertebrobasilar dissecting aneurysms with brain stem compression treated from January 2009 to December 2017. Treatment methods were observation ( = 6), stent-assisted coil embolization ( = 9), parent artery occlusion ( = 6), and flow diversion ( = 7). The data of baseline characteristics, change of aneurysm size, retreatment rate, stroke occurrence, and alteration of the mRS score were obtained from retrospective chart review.
The initial size of dissecting aneurysms was largest in the flow diversion group (22.5 ± 7.7 mm), followed by parent artery occlusion (20.3 ± 8.4 mm), stent-assisted coil embolization (11.7 ± 2.2 mm), and observation (17.8 ± 5.5 mm; = .01) groups. The reduction rate of aneurysm size was highest in the parent artery occlusion group (26.7 ± 32.1%), followed by flow diversion (14.1% ± 28.7%), stent-assisted coil embolization (-17.9 ± 30.3%), and observation (-31.5 ± 30.8%; = .007) groups. Additional treatment was needed in the observation (4/6, 66.7%) and stent-assisted coil embolization (3/9, 33.3%; = .017) groups. Improvement of the mRS score on follow-up was observed in the flow diversion (6/7, 85.7%) and parent artery occlusion (4/6, 66.7%) groups but not in the stent-assisted coil embolization and observation groups. A worsened mRS score was most common in the observation group (4/6, 66.7%), followed by stent-assisted coil embolization (3/9, 33.3%), parent artery occlusion (2/6, 33.3%), and flow diversion (0/7, 0%) groups.
When treating intracranial vertebrobasilar dissecting aneurysms with brain stem compression, parent artery occlusion and flow diversion should be considered to reduce aneurysm size and improve the mRS score.
未破裂的颅内椎基底动脉夹层动脉瘤伴脑干压迫的治疗较为困难。本研究旨在评估不同治疗方式治疗未破裂的颅内椎基底动脉夹层动脉瘤伴脑干压迫的临床和影像学转归。
本研究纳入了 2009 年 1 月至 2017 年 12 月期间接受治疗的 28 例未破裂的颅内椎基底动脉夹层动脉瘤伴脑干压迫患者。治疗方法包括观察（n=6）、支架辅助弹簧圈栓塞（n=9）、载瘤动脉闭塞（n=6）和血流导向装置（n=7）。通过回顾性病历分析，获得了患者的基线特征、动脉瘤大小变化、再治疗率、卒中发生情况和 mRS 评分改变的数据。
血流导向装置组患者的夹层动脉瘤初始直径最大（22.5±7.7mm），其次为载瘤动脉闭塞组（20.3±8.4mm）、支架辅助弹簧圈栓塞组（11.7±2.2mm）和观察组（17.8±5.5mm；=0.01）。载瘤动脉闭塞组的动脉瘤直径缩小率最高（26.7%±32.1%），其次为血流导向装置组（14.1%±28.7%）、支架辅助弹簧圈栓塞组（-17.9%±30.3%）和观察组（-31.5%±30.8%；=0.007）。观察组（4/6，66.7%）和支架辅助弹簧圈栓塞组（3/9，33.3%；=0.017）需要额外治疗。血流导向装置组（6/7，85.7%）和载瘤动脉闭塞组（4/6，66.7%）的 mRS 评分在随访时得到改善，但支架辅助弹簧圈栓塞组和观察组的 mRS 评分无明显变化。观察组（4/6，66.7%）的 mRS 评分恶化最为常见，其次是支架辅助弹簧圈栓塞组（3/9，33.3%）、载瘤动脉闭塞组（2/6，33.3%）和血流导向装置组（0/7，0%）。
治疗伴有脑干压迫的颅内椎基底动脉夹层动脉瘤时，应考虑采用载瘤动脉闭塞和血流导向装置来缩小动脉瘤直径并改善 mRS 评分。
