Nagano Yushi, Ikedo Taichi, Shimonaga Koji, Kushi Yuji, Hamano Eika, Imamura Hirotoshi, Mori Hisae, Hanaya Ryosuke, Iihara Koji, Kataoka Hiroharu
Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, JPN.
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, JPN.
Cureus. 2024 Aug 14;16(8):e66851. doi: 10.7759/cureus.66851. eCollection 2024 Aug.
Tentorium resection and detachment from the oculomotor nerve are sometimes required for surgical clipping of unruptured posterior communicating artery (PCoA) aneurysms. Using T2-weighted 3D images, we aimed to identify the preoperative radiological features required to determine the necessity of these additional procedures.
We reviewed 30 patients with unruptured PCoA aneurysms who underwent surgical clipping and preoperative simulation using T2-weighted 3D images for measurement of the distance between the tentorium and aneurysm. Aneurysms were classified into superior type (superior to the tentorium) and inferior type (inferior to the tentorium).
Seven patients (23%) underwent tentorium resection; all had the inferior type (superior vs. inferior, 0% vs. 33%, p = 0.071). In the 21 patients with the inferior type, the distance from the tentorium to the aneurysmal neck was 2.2 ± 1.1 mm and 0.0 ± 0.5 mm without and with tentorium resection (p < 0.01), respectively. An optimal cutoff value of ≤ +0.84 mm was identified for tentorium resection (area under the curve (AUC) = 0.96). Furthermore, 17 patients (57%) showed tight aneurysm attachment to the oculomotor nerve; all had the inferior type (0% vs. 81%, p < 0.01). The distance from the aneurysm tip to the tentorium was 1.1 ± 1.2 mm and -1.7 ± 1.4 mm without and with attachment (p < 0.01). The optimal cutoff value was ≤ +0.45 mm (AUC = 0.92).
Measurement of the distance between the tentorium and aneurysmal neck or tip with T2-weighted 3D images is effective for preoperative simulation for surgical clipping of PCoA aneurysms.
对于未破裂的后交通动脉（PCoA）动脉瘤进行手术夹闭时，有时需要切除小脑幕并使其与动眼神经分离。我们旨在利用T2加权三维图像确定术前影像学特征，以判断这些额外操作的必要性。
我们回顾了30例接受手术夹闭及术前使用T2加权三维图像模拟测量小脑幕与动脉瘤之间距离的未破裂PCoA动脉瘤患者。动脉瘤分为上型（位于小脑幕上方）和下型（位于小脑幕下方）。
7例患者（23%）接受了小脑幕切除术；均为下型（上型与下型，0% 对33%，p = 0.071）。在21例下型患者中，小脑幕至动脉瘤颈部的距离在未行小脑幕切除时为2.2±1.1mm，行小脑幕切除时为0.0±0.5mm（p<0.01）。确定小脑幕切除的最佳截断值为≤ +0.84mm（曲线下面积（AUC）= 0.96）。此外，17例患者（57%）表现为动脉瘤与动眼神经紧密相连；均为下型（0% 对81%，p<0.01）。动脉瘤顶端至小脑幕的距离在未相连时为1.1±1.2mm，相连时为 -1.7±1.4mm（p<0.01）。最佳截断值为≤ +0.45mm（AUC = 0.92）。
利用T2加权三维图像测量小脑幕与动脉瘤颈部或顶端之间的距离，对于PCoA动脉瘤手术夹闭的术前模拟是有效的。
