Willis环的解剖变异与颅内动脉瘤的形成及破裂：一项系统评价与荟萃分析。
Anatomical variations in the Circle of Willis and the formation and rupture of intracranial aneurysms: A systematic review and meta-analysis.
作者信息
Feng Lu, Mao He-Jiao, Zhang Ding-Ding, Zhu Yi-Cheng, Han Fei
机构信息
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Front Neurol. 2023 Jan 16;13:1098950. doi: 10.3389/fneur.2022.1098950. eCollection 2022.
BACKGROUND
The anterior (AcomA) and posterior communicating arteries (PcomA) are two of the most frequent sites for intracranial aneurysms. Anatomical variations in the Circle of Willis (COW) are frequently observed in patients with AcomA and PcomA aneurysms. Strong evidence is needed to determine the pooled estimate of the effect of COW variations on the formation and rupture of these aneurysms.
AIM
This systematic review and meta-analysis aimed to establish the effect of COW variations on the formation and rupture of AcomA and PcomA aneurysms using available studies.
SUMMARY OF REVIEW
PubMed, Embase, and Web of Science databases were systematically searched for studies published in English before September 21, 2022. Studies investigating AcomA aneurysms and the hypoplastic/aplastic A1 segment of the anterior cerebral artery and PcomA aneurysms and hypoplastic/aplastic PcomA or fetal-type posterior cerebral artery (FTP) were included. The heterogeneity of the studies was assessed using Cochran -test and I statistic. Pooled estimate was assessed using either a random- or fixed-effects model based on the heterogeneity of the studies. Among the 4,932 studies, 21 were eligible and included in the analysis. The presence of hypoplastic/aplastic A1 was significantly correlated with the formation [OR (95% confidence interval [CI]) = 7.97 (5.58, 11.39), < 0.001] and rupture [OR (95%CI) = 1.87 (1.29, 2.72), < 0.001] of AcomA aneurysms. Significant associations between FTP and both the formation [OR (95%CI) = 2.15 (1.41, 3.30), < 0.001] and rupture [OR (95%CI) = 1.72 (1.26, 2.36), < 0.001] of PcomA aneurysms were observed.
CONCLUSIONS
Significant associations were observed between COW variations and both the formation and rupture of AcomA and PcomA aneurysms. This can help in determining interventions for patients with aneurysms.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225149, identifier: CRD42021225149.
背景
前交通动脉（AcomA）和后交通动脉（PcomA）是颅内动脉瘤最常见的两个部位。在患有前交通动脉和后交通动脉动脉瘤的患者中，经常观察到Willis环（COW）的解剖变异。需要有力的证据来确定Willis环变异对这些动脉瘤形成和破裂影响的合并估计值。
目的
本系统评价和荟萃分析旨在利用现有研究确定Willis环变异对前交通动脉和后交通动脉动脉瘤形成和破裂的影响。
综述总结
系统检索了PubMed、Embase和Web of Science数据库，以查找2022年9月21日前发表的英文研究。纳入了调查前交通动脉动脉瘤以及大脑前动脉A1段发育不全/未发育和后交通动脉动脉瘤以及后交通动脉发育不全/未发育或胎儿型大脑后动脉（FTP）的研究。使用Cochran检验和I统计量评估研究的异质性。根据研究的异质性，使用随机效应模型或固定效应模型评估合并估计值。在4932项研究中，21项符合条件并纳入分析。A1段发育不全/未发育与前交通动脉动脉瘤的形成[比值比（95%置信区间[CI]）=7.97（5.58，11.39），P<0.001]和破裂[比值比（95%CI）=1.87（1.29，2.72），P<0.001]显著相关。观察到胎儿型大脑后动脉与后交通动脉动脉瘤的形成[比值比（95%CI）=2.15（1.41，3.30），P<0.001]和破裂[比值比（95%CI）=1.72（1.26，2.36），P<0.001]均存在显著关联。
结论
观察到Willis环变异与前交通动脉和后交通动脉动脉瘤的形成及破裂均存在显著关联。这有助于确定动脉瘤患者的干预措施。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225149，标识符：CRD42021225149。
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