Take Yushiro, Kamide Tomoya, Kikkawa Yuichiro, Ikegami Masaki, Teranishi Akio, Ehara Takuro, Shibata Aoto, Suzuki Kaima, Ikeda Toshiki, Iihoshi Satoshi, Kohyama Shinya, Kurita Hiroki
Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
Department of Neuroendovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
Surg Neurol Int. 2021 Apr 19;12:171. doi: 10.25259/SNI_223_2021. eCollection 2021.
Distal anterior cerebral artery (ACA) aneurysms are rare, representing 1-9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continues to be debated. We clarified the clinical features and treatment outcomes of patients with ruptured distal ACA aneurysms according to the treatment options at our institute.
Thirty-seven consecutive patients (26 women; mean age, 65.2 years) with ruptured distal ACA aneurysms who underwent surgical clipping or coil embolization between 2012 and 2018 were included in the study. Clinical presentations, radiographic findings, and outcomes were retrospectively reviewed and compared between patients who underwent either surgical clipping or coil embolization. Risk factors associated with poor outcomes (modified Rankin Scale 4-6) were analyzed using multiple regression analysis.
Nineteen patients (51.4%) had World Federation Neurological Surgeons (WFNS) Grade IV-V, 18 (48.7%) had frontal lobe hematomas, and 13 (35.1%) had multiple aneurysms. Surgical clipping and endovascular coiling were performed in 28 (75.7%) and nine (24.3%) patients, respectively. Aneurysms located at the A4-5 portions were mainly treated by surgical clipping ( = 0.04). There were no significant between-group differences in procedure-related morbidity and mortality; however, the complete occlusion rate was higher in the surgical group ( < 0.01). Overall, a favorable neurological outcome at discharge (mRS 0-3) was obtained in 23 patients (62.5%). Multiple regression analysis revealed that WFNS Grade IV-V and frontal lobe hematomas were risk factors for poor outcomes (mRS 4-6).
Acceptable outcomes were obtained in 62.5% of cases, and there were no significant between-group differences in treatment results between clipping and coiling. A poor WFNS grade and intracerebral hematomas were risk factors for a poor prognosis.
大脑前动脉（ACA）远端动脉瘤较为罕见，占所有颅内动脉瘤的1 - 9%。对于这些动脉瘤的最佳治疗策略仍存在争议。我们根据本机构的治疗方案，阐明了破裂的ACA远端动脉瘤患者的临床特征和治疗结果。
本研究纳入了2012年至2018年间连续37例接受手术夹闭或弹簧圈栓塞治疗的破裂ACA远端动脉瘤患者（26例女性；平均年龄65.2岁）。对接受手术夹闭或弹簧圈栓塞治疗的患者的临床表现、影像学检查结果和预后进行回顾性分析和比较。采用多元回归分析与不良预后（改良Rankin量表4 - 6级）相关的危险因素。
19例患者（51.4%）为世界神经外科联合会（WFNS）IV - V级，18例（48.7%）有额叶血肿，13例（35.1%）有多发动脉瘤。分别有28例（75.7%）和9例（24.3%）患者接受了手术夹闭和血管内栓塞治疗。位于A4 - 5段的动脉瘤主要采用手术夹闭治疗（P = 0.04）。两组在手术相关的发病率和死亡率方面无显著差异；然而，手术组的完全闭塞率更高（P < 0.01）。总体而言，23例患者（62.5%）出院时神经功能预后良好（mRS 0 - 3）。多元回归分析显示，WFNS IV - V级和额叶血肿是不良预后（mRS 4 - 6）的危险因素。
62.5%的病例获得了可接受的预后，夹闭和栓塞治疗结果在组间无显著差异。WFNS分级差和脑内血肿是预后不良 的危险因素。
