Byun Joonho, Park Wonhyoung, Park Jung Cheol, Ahn Jae Sung
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2021 Jan;64(1):39-50. doi: 10.3340/jkns.2020.0028. Epub 2020 Dec 23.
The treatment of large aneurysms of the posterior circulation is complicated and remains challenging. We here analyzed our institutional clinical outcomes of large unruptured aneurysms of the posterior circulation.
This study included 56 patients who presented with a large (>10 mm) unruptured aneurysm of the posterior circulation between 2002 and 2018.
There were 18 (32.1%) male and 38 (67.9%) female patients, with a mean age of 53.4 years. The most common location was the vertebral artery, followed by the basilar tip and posterior cerebral artery. The median follow-up duration was 29 months. Eighteen patients (32.1%) were treated by transcranial surgery and 38 (67.9%) were treated by endovascular treatment (EVT). Posttreatment complications occurred in 16 patients (28.6%), with there being no significant difference between the transcranial surgery and EVT groups. Complete obliteration was achieved in 30 patients (53.6%), with there being no statistically significant difference between the transcranial surgery and EVT groups. Recurrence occurred in 17 patients (30.4%), and the rate of recurrence was higher in the EVT group than in the transcranial surgery group (39.5% vs. 11.1%, p=0.03). Forty-four (84%) of 56 patients showed a favorable functional outcome. In saccular aneurysm, EVT was negative predictor of worsening of functional status.
Treatment of these aneurysms harbors an inherent high risk of morbidity. No superiority was found between transcranial surgery and EVT in terms of complications and complete obliteration, but transcranial surgery showed a higher treatment durability than EVT.
后循环大型动脉瘤的治疗复杂且仍具挑战性。我们在此分析了我院后循环大型未破裂动脉瘤的临床治疗结果。
本研究纳入了2002年至2018年间出现后循环大型（>10mm）未破裂动脉瘤的56例患者。
男性患者18例（32.1%），女性患者38例（67.9%），平均年龄53.4岁。最常见的部位是椎动脉，其次是基底动脉尖和大脑后动脉。中位随访时间为29个月。18例患者（32.1%）接受了经颅手术治疗，38例患者（67.9%）接受了血管内治疗（EVT）。16例患者（28.6%）出现治疗后并发症，经颅手术组和EVT组之间无显著差异。30例患者（53.6%）实现了完全闭塞，经颅手术组和EVT组之间无统计学显著差异。17例患者（30.4%）出现复发，EVT组的复发率高于经颅手术组（39.5%对11.1%，p=0.03）。56例患者中有44例（84%）显示功能预后良好。在囊状动脉瘤中，EVT是功能状态恶化的负性预测因素。
这些动脉瘤的治疗存在固有的高发病风险。在并发症和完全闭塞方面，经颅手术和EVT之间未发现优势，但经颅手术显示出比EVT更高的治疗持久性。
