Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
Neurosurg Rev. 2022 Jun;45(3):2457-2470. doi: 10.1007/s10143-022-01734-2. Epub 2022 Mar 19.
Posterior communicating artery (PCoA) aneurysm is common and sometimes requires microsurgery; however, as data on premammillary artery (PMA) infarction after clipping is scarce, we retrospectively reviewed cases of post-clipping PMA infarction to analyze incidence, independent risk factors of infarction, and anatomical considerations. Data from 569 consecutive patients who underwent microsurgical clipping for unruptured PCoA aneurysm between January 2008 and December 2020 were included. Patients were categorized into the normal or the PMA infarction group. Statistical analyses and comparisons between the two groups were used to determine the influence of various factors. The normal group included 515 patients while the PMA infarction group had 31. The mean length of hospital stay was significantly longer in the PMA infarction group (10.3 ± 9.1 days) than in the normal group (6.5 ± 6.4 days; p < 0.0001). The distribution of Glasgow Outcome Scale at discharge was significantly different between the two groups (p ≤ 0.0001) but was not so at 6 months after discharge (p = 0.0568). Multivariate logistic regression analysis identified aneurysm size (odds ratio [OR], 1.194; 95% confidence interval [CI], 1.08-1.32; p = 0.0005) and medial direction of aneurysm (OR, 4.615; 95% CI, 1.224-17.406; p = 0.0239) as independent risk factors of post-clipping PMA infarction. Surgeons must beware of PMA infarction after clipping of large aneurysms that are medial in direction. Intraoperative verification of the patency of the PCoA and the PMA from various angles using various intraoperative methods can reduce morbidity due to PMA infarction.
后交通动脉（PCoA）动脉瘤很常见，有时需要进行显微手术；然而，由于夹闭术后发生-premammillary artery（PMA）梗死的相关数据较少，我们回顾性分析了夹闭术后发生 PMA 梗死的病例，以分析梗死的发生率、独立的危险因素和解剖学考虑因素。纳入了 2008 年 1 月至 2020 年 12 月期间 569 例连续接受显微手术夹闭未破裂 PCoA 动脉瘤的患者的数据。将患者分为正常组或 PMA 梗死组。对两组之间的各种因素进行统计分析和比较，以确定其影响。正常组包括 515 例患者，PMA 梗死组 31 例。PMA 梗死组的平均住院时间（10.3±9.1 天）明显长于正常组（6.5±6.4 天；p<0.0001）。两组出院时的格拉斯哥预后量表分布差异有统计学意义（p≤0.0001），但在出院后 6 个月差异无统计学意义（p=0.0568）。多因素 logistic 回归分析发现，动脉瘤大小（优势比[OR]，1.194；95%置信区间[CI]，1.08-1.32；p=0.0005）和动脉瘤的内侧方向（OR，4.615；95%CI，1.224-17.406；p=0.0239）是夹闭术后 PMA 梗死的独立危险因素。对于指向内侧的大动脉瘤，夹闭后应警惕发生 PMA 梗死。术中应从多个角度使用各种术中方法验证 PCoA 和 PMA 的通畅性，以降低因 PMA 梗死导致的发病率。
