Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 05505, Seoul, South Korea.
Acta Neurochir (Wien). 2023 Feb;165(2):501-515. doi: 10.1007/s00701-023-05487-9. Epub 2023 Jan 18.
An anterior communicating artery is a common location for both ruptured and unruptured intracranial aneurysms, and microsurgery is sometimes necessary for their successful treatment. However, postoperative infarction should be considered during clipping due to the complex surrounding structures of anterior communicating artery aneurysms. This study aimed to evaluate the risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms and its clinical outcomes.
The data of patients who underwent microsurgical clipping of an unruptured anterior communicating artery aneurysm in our hospital between January 2008 and December 2020 were retrospectively analyzed. The patients' demographic data, anatomical features of the anterior communicating artery complex and aneurysm, surgical technique, characteristics of postoperative infarction, and its clinical course were evaluated.
Notably, among 848 patients, 66 (7.8%) and 34 (4%) patients had radiologic and symptomatic infarctions, respectively. Univariate and multivariate logistic regression analyses showed that hypertension (odds ratio (OR), 1.99; [Formula: see text]), previous stroke (OR, 3.89; [Formula: see text]), posterior projection (OR, 5.58; [Formula: see text]), aneurysm size (OR, 1.17; optimal cut-off value, 6.14 mm; [Formula: see text]), and skull base-to-aneurysm distance (OR, 1.15; optimal cut-off value, 11.09 mm; [Formula: see text]) were associated with postoperative infarction. In the pterional approach, a closed A2 plane was an additional risk factor (OR, 1.88; [Formula: see text]). Infarction of the subcallosal and hypothalamic branches was significantly associated with symptomatic infarction ([Formula: see text]).
Hypertension, previous stroke, posteriorly projecting aneurysms, aneurysm size, and highly positioned aneurysms are independent risk factors for postoperative infarction during surgical clipping of an unruptured anterior communicating artery aneurysm. Additionally, a closed A2 plane is an additional risk factor of postoperative infarction in patients undergoing clipping via the pterional approach.
前交通动脉是破裂和未破裂颅内动脉瘤的常见部位，有时需要进行显微手术治疗。然而，由于前交通动脉动脉瘤周围结构复杂，在夹闭过程中应考虑术后梗死的风险。本研究旨在评估未破裂前交通动脉动脉瘤显微手术后梗死的危险因素及其临床转归。
回顾性分析我院 2008 年 1 月至 2020 年 12 月期间接受显微手术夹闭未破裂前交通动脉动脉瘤的患者资料。评估患者的人口统计学数据、前交通动脉复合体和动脉瘤的解剖特征、手术技术、术后梗死的特征及其临床过程。
在 848 例患者中，有 66 例（7.8%）和 34 例（4%）患者发生影像学和症状性梗死。单因素和多因素逻辑回归分析表明，高血压（比值比（OR），1.99；[公式：见文本]）、既往卒中（OR，3.89；[公式：见文本]）、后向突出（OR，5.58；[公式：见文本]）、动脉瘤大小（OR，1.17；最佳截断值，6.14mm；[公式：见文本]）和颅底至动脉瘤距离（OR，1.15；最佳截断值，11.09mm；[公式：见文本]）与术后梗死相关。在翼点入路中，A2 段关闭是另一个危险因素（OR，1.88；[公式：见文本]）。前交通动脉分支和下丘脑分支的梗死与症状性梗死显著相关（[公式：见文本]）。
高血压、既往卒中、后向突出的动脉瘤、动脉瘤大小和位置较高的动脉瘤是未破裂前交通动脉动脉瘤显微手术后梗死的独立危险因素。此外，翼点入路夹闭患者的 A2 段关闭是术后梗死的另一个危险因素。
