Meharry Medical College, Nashville, TN, USA.
Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Neurosurg Rev. 2023 Oct 2;46(1):260. doi: 10.1007/s10143-023-02171-5.
Extracranial vertebral artery aneurysms are rare complications resulting from trauma and multiple different diseases. However, the difference between clinical and surgical profiles is well understood. To investigate the clinical and interventional outcomes following extracranial vertebral artery aneurysms (VAA) treatment through a systematic review of the literature to date, an electronic database search for full-text English articles was conducted following PRISMA guidelines. The search yielded results on clinical and surgical outcomes for extracranial VAAs. These results included patient-specific risk factors, indications, and techniques. Our literature search resulted in 561 articles, of which 36 studies were qualified to be included in the analysis. A total of 55 patients with multiple various extracranial VAA incidents were included. The mean age of subjects was 42 years (ranging from 13.0 to 76.0 years), and the majority of patients were males (71%, n =39). Blunt trauma was the most frequent risk factor for extracranial VAA formation (35%, n = 19). The majority of aneurysms (60%) were dissected in nature. The most common form of treatment for extracranial VAAs was the use of a flow diverter (24%, n=13). Overall, five (9%) patients had long-term adverse neurological complications following intervention with 5% (n=3) mortality, 2% (n=1) resulting in unilateral vocal cord paralysis, and 2% (n=1) resulted in a positive Romberg sign. The mortality rate is 15.7% in the surgical group, whereas the endovascular treatment did not result in any mortality. The endovascular approach is a safe and effective treatment of extracranial VAAs due to its relatively low overall complication rate and lack of resulting mortality. This is in contrast to the surgical approach which results in a higher rate of complications, recurrence, and mortality outcomes. An understanding of the factors and clinical outcomes associated with the incidence of extracranial VAAs is essential for the future improvement of patient outcomes.
颅外椎动脉动脉瘤是创伤和多种不同疾病导致的罕见并发症。然而，临床和手术特征之间的差异是众所周知的。为了通过对迄今为止文献的系统回顾，研究颅外椎动脉动脉瘤（VAA）治疗后的临床和介入结果，我们按照 PRISMA 指南对全文为英文的文章进行了电子数据库检索。该检索结果包括与患者特定风险因素、适应证和技术相关的颅外 VA 结果。我们的文献检索产生了 561 篇文章，其中 36 项研究符合纳入分析的标准。共有 55 例患有多种不同的颅外 VAA 事件的患者被纳入。受试者的平均年龄为 42 岁（范围为 13.0 至 76.0 岁），大多数患者为男性（71%，n=39）。钝性创伤是颅外 VAA 形成的最常见危险因素（35%，n=19）。大多数动脉瘤（60%）为夹层。颅外 VAAs 的最常见治疗形式是使用血流导向装置（24%，n=13）。总体而言，5 例（9%）患者在干预后出现长期不良神经并发症，5%（n=3）死亡，2%（n=1）出现单侧声带麻痹，2%（n=1）出现阳性 Romberg 征。手术组的死亡率为 15.7%，而血管内治疗组没有导致任何死亡。血管内治疗是颅外 VAAs 的一种安全有效的治疗方法，因为其总体并发症发生率相对较低，并且不会导致死亡。这与手术方法形成对比，手术方法会导致更高的并发症、复发和死亡率。了解与颅外 VAAs 发生率相关的因素和临床结果对于未来改善患者预后至关重要。
