Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
World Neurosurg. 2023 Dec;180:e108-e116. doi: 10.1016/j.wneu.2023.08.129. Epub 2023 Sep 9.
The mass effect associated with large or giant intracranial aneurysms is difficult for traditional endovascular treatment. This study investigated whether flow diverters can relieve the aneurysmal mass effect caused by aneurysmal compression symptoms.
Fifty-five patients with unruptured large and giant intracranial aneurysms treated by a flow diverter at our institution from January 2014 to February 2022 were retrospectively evaluated.
In this study, 53 patients were included. Initially, 27 patients (51.9%), including 10 with compressive optic neuropathy, 12 with third nerve palsy, 2 with facial hyperesthesia, and 11 with sixth nerve palsy, were symptomatic. The symptom duration was shorter in the improved group (n = 2.2 ± 4.0 vs. n = 3.1 ± 3.9, P = 0.49). Thrombus formation following the flow diversion procedure was typically observed on magnetic resonance imaging (MRI) performed immediately and was not significantly associated with symptomatic improvement (OR = 0.395; 95% CI (0.058-2.698), P = 0.343). However, symptomatic improvement was seen in most patients when the aneurysm size decreased on MRI. A reduction in the aneurysm size on the MRI at the 3-month follow-up was correlated with symptomatic improvement in the multivariate analysis (OR = 0.08, 95% CI (0.013-0.485), P < 0.05).
A flow diverter might help alleviate compression symptoms caused by large or giant intracranial aneurysms. Shrinkage of the aneurysm within 3 months postoperatively and a shorter duration of symptoms contribute to the favorable outcomes of mass effect. Ultimately, prompt treatment is crucial for improving symptomatic intracranial artery aneurysms.
与大型或巨大颅内动脉瘤相关的肿块效应，传统的血管内治疗难以处理。本研究旨在探讨血流导向装置是否可以缓解由动脉瘤压迫症状引起的动脉瘤肿块效应。
回顾性分析 2014 年 1 月至 2022 年 2 月在我院接受血流导向装置治疗的 55 例未破裂大型和巨大颅内动脉瘤患者的临床资料。
本研究共纳入 53 例患者，其中 27 例（51.9%）患者有压迫性视神经病变、动眼神经麻痹、三叉神经麻痹、面感觉异常、展神经麻痹等压迫症状，在改善组中，症状持续时间较短（n=2.2±4.0 比 n=3.1±3.9，P=0.49）。即刻行磁共振成像（MRI）检查发现，血流导向装置术后血栓形成典型，但与症状改善无显著相关性（OR=0.395；95%CI（0.058-2.698），P=0.343）。然而，当 MRI 显示动脉瘤缩小，大多数患者的症状会得到改善。多因素分析显示，3 个月 MRI 随访时动脉瘤缩小与症状改善相关（OR=0.08，95%CI（0.013-0.485），P<0.05）。
血流导向装置可能有助于缓解由大型或巨大颅内动脉瘤引起的压迫症状。术后 3 个月内动脉瘤缩小和症状持续时间较短有助于改善肿块效应的预后。总之，及时治疗对于改善有症状的颅内动脉动脉瘤至关重要。
