Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany.
Department of Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany.
Acta Neurochir (Wien). 2021 Jan;163(1):131-138. doi: 10.1007/s00701-020-04639-5. Epub 2020 Nov 20.
Aneurysm residuals after clipping are a well-known problem, but the course of aneurysm remnants in follow-up is not well studied. No standards or follow-up guidelines exist for treatment of aneurysm remnants. The aim of this study was to evaluate the risk factors for postoperative aneurysm remnants and their changes during follow-up.
We performed a retrospective analysis of 666 aneurysms treated via clipping in our hospital from 2006 to 2016. Postoperative and follow-up angiographic data were analyzed for aneurysm remnants and regrowth. Clinical parameters and aneurysm-specific characteristics were correlated with radiological results.
The frequency of aneurysm residuals was 12% (78/666). Aneurysms located in the middle cerebral artery (p = 0.02) showed a significantly lower risk for incomplete aneurysm occlusion. Larger aneurysms with a diameter of 11-25 mm (p = 0.005) showed a significantly higher risk for incomplete aneurysm occlusion. Five patients underwent re-clipping during the same hospital stay. Remnants were stratified based on morphological characteristics into "dog ears" (n = 60) and "broad based" (n = 13). The majority of the "dog ears" stayed stable, decreased in size, or vanished during follow-up. Broad-based remnants showed a higher risk of regrowth.
A middle cerebral artery location seems to lower the risk for the incomplete clip occlusion of an aneurysm. Greater aneurysm size (11-25 mm) is associated with a postoperative aneurysm remnant. The majority of "dog-ear" remnants appear to remain stable during follow-up. In these cases, unnecessarily frequent angiographic checks could be avoided. By contrast, broad-based residuals show a higher risk of regrowth that requires close imaging controls if retreatment cannot be performed immediately.
夹闭术后动脉瘤残腔是一个众所周知的问题，但动脉瘤残腔在随访中的变化过程尚未得到充分研究。目前尚无针对动脉瘤残腔的治疗标准或随访指南。本研究旨在评估术后动脉瘤残腔的危险因素及其在随访过程中的变化。
我们对 2006 年至 2016 年期间在我院接受夹闭治疗的 666 个动脉瘤进行了回顾性分析。对术后和随访的血管造影数据进行分析，以评估动脉瘤残腔和再生长情况。将临床参数和动脉瘤特征与影像学结果相关联。
动脉瘤残腔的发生率为 12%（78/666）。位于大脑中动脉的动脉瘤（p=0.02）不完全闭塞的风险显著降低。直径为 11-25mm 的较大动脉瘤（p=0.005）不完全闭塞的风险显著增加。5 例患者在同一住院期间接受了再次夹闭。根据形态学特征将残腔分为“犬耳状”（n=60）和“基底宽”（n=13）。大多数“犬耳状”残腔在随访过程中保持稳定、缩小或消失。基底宽的残腔有更高的再生长风险。
大脑中动脉的位置似乎降低了动脉瘤不完全夹闭的风险。较大的动脉瘤大小（11-25mm）与术后动脉瘤残腔相关。大多数“犬耳状”残腔在随访过程中似乎保持稳定。在这些情况下，可以避免不必要的频繁血管造影检查。相比之下，基底宽的残腔有更高的再生长风险，如果不能立即进行再次治疗，则需要密切的影像学监测。
