大脑中动脉破裂动脉瘤不同出血模式下的外侧裂形态和血管解剖结构的作用。

The role of the Sylvian fissure configuration and the vascular anatomy on different bleeding patterns in ruptured middle cerebral artery aneurysms.

机构信息

Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany.

出版信息

Clin Neurol Neurosurg. 2020 Feb;189:105572. doi: 10.1016/j.clineuro.2019.105572. Epub 2019 Oct 31.

DOI:10.1016/j.clineuro.2019.105572

PMID:31786430

Abstract

OBJECTIVE

Ruptured middle cerebral artery (MCA) aneurysms are one of the causes of subarachnoid (SAH) or intracerebral hemorrhage (ICH) but the factors associated with the bleeding type are unknown. The aim of the study was to analyze the association of the morphological variations of the Sylvian fissure (SF) and vascular parameters on occurrence of different bleeding patterns in patients with ruptured MCA aneurysms.

PATIENTS AND METHODS

The data of consecutive 202 patients with ruptured MCA aneurysm of two centers were included for analysis. Patients were divided into three groups: Group 1 with SAH, Group 2 with accompanying ICH and Group 3 with intrasylvian hemorrhage (ISH). The SF was divided into five types according to the previously described classification. Analyzed vascular parameters were aneurysm size, localization, presence of a daughter aneurysm, shape, and angulation of the aneurysm sac.

RESULTS

A total of 202 patients (141 female, 61 male, mean age 52.4 yr) were included in this study. 67 patients (33.2%) had a SAH, 122 (60.4%) an ICH and 13 (6.4%) presented with ISH. Statistical analysis showed a significant association of narrow and twisted SF types 4 and 5 (p < 0.001) and temporal angulation of the aneurysm (p = 0.030) for occurrence of ICH. All other vascular parameters showed no significant association for any kind of hemorrhage.

CONCLUSION

Our results allow the conclusion that the complex SF types 4 and 5, as well as the temporal angulation of the aneurysm sac are associated with the occurrence of ICH in ruptured MCA aneurysms.

摘要

目的

大脑中动脉（MCA）破裂动脉瘤是蛛网膜下腔出血（SAH）或脑内出血（ICH）的原因之一，但与出血类型相关的因素尚不清楚。本研究旨在分析大脑中动脉破裂动脉瘤患者的大脑外侧裂（SF）形态变异与血管参数与不同出血类型发生的关系。

方法

本研究纳入了两个中心的 202 例大脑中动脉破裂动脉瘤患者的数据进行分析。患者被分为三组：组 1 为单纯 SAH 组，组 2 为伴有 ICH 组，组 3 为大脑中动脉破裂动脉瘤内出血（IS）组。根据之前描述的分类，SF 分为五型。分析的血管参数包括动脉瘤大小、定位、是否存在子瘤、动脉瘤囊的形状和角度。

结果

本研究共纳入 202 例患者（141 例女性，61 例男性，平均年龄 52.4 岁）。67 例（33.2%）为单纯 SAH，122 例（60.4%）为 ICH，13 例（6.4%）为 ISH。统计学分析显示，狭窄和扭曲的 SF 类型 4 和 5（p<0.001）以及动脉瘤囊的颞向角度（p=0.030）与 ICH 的发生有显著相关性。所有其他血管参数与任何类型的出血均无显著相关性。