Malvea Anahita, Miyake Shigeta, Agid Ronit, Barazarte Hugo Andrade, Farb Richard, Krings Timo, Mosimann Pascal John Roger, Nicholson Patrick Joseph, Radovanovic Ivan, Terbrugge Karel, Willinsky Robert, Schaafsma Joanna Danielle, Hendriks Eef J
Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON M5T 2S8, Canada.
Department of Neurosurgery, Yokohama City University School of Medicine, Yokohama 236-0027, Japan.
Brain Sci. 2024 Sep 19;14(9):934. doi: 10.3390/brainsci14090934.
Posterior cerebral artery (PCA) aneurysms represent up to 1% of all cerebral aneurysms. P1-P2 perforator aneurysms are thought to be even less prevalent and often require complex treatment strategies due to their anatomical and morphological characteristics, with risk of a perforator infarct. We studied the treatment of P1-P2 perforator aneurysms in a single-center cohort from a high-volume tertiary center, reporting clinical and anatomical characteristics, treatment strategies, and outcomes.
A retrospective analysis of adult patients with a P1-P2 perforator aneurysm who presented at our institution between January 2000 and January 2023 was performed. The patients were analyzed for demographics, clinical presentation, imaging findings, treatment techniques, outcomes, and complications. Subgroup analyses between ruptured versus non-ruptured cases were included.
Out of 2733 patients with a cerebral aneurysm, 14 patients (0.5%) presented with a P1-P2 perforator aneurysm. All six patients with a ruptured aneurysm were treated by endovascular coiling, of whom one patient (16.7%) required surgical clipping of a recurrence. One out of eight (12.5%) patients with unruptured aneurysms was treated by surgical clipping. P1-P2 perforator aneurysms predominantly affected middle-aged individuals (median 59.5 years), with 10/14 (71.4%) being female. Endovascular coiling was the primary treatment modality overall, yielding favorable technical outcomes, however, it was complicated by a perforator infarct in two patients (33.3%) without new permanent morbidity or mortality secondary to treatment.
P1-P2 perforator aneurysms are a rare subtype of intracranial aneurysm. Endovascular coiling could present an effective treatment modality; however, care should be taken for ischemic complications in the dependent perforator territory. Larger studies are required to provide more insights.
大脑后动脉（PCA）动脉瘤占所有脑动脉瘤的比例高达1%。P1-P2穿支动脉瘤被认为更为罕见，由于其解剖和形态特征，通常需要复杂的治疗策略，且存在穿支梗死的风险。我们在一个来自高容量三级中心的单中心队列中研究了P1-P2穿支动脉瘤的治疗，报告了临床和解剖特征、治疗策略及结果。
对2000年1月至2023年1月在我院就诊的成年P1-P2穿支动脉瘤患者进行回顾性分析。对患者的人口统计学、临床表现、影像学检查结果、治疗技术、结果及并发症进行分析。纳入破裂与未破裂病例的亚组分析。
在2733例脑动脉瘤患者中，14例（0.5%）为P1-P2穿支动脉瘤。所有6例破裂动脉瘤患者均接受了血管内栓塞治疗，其中1例（16.7%）复发后需要手术夹闭。8例未破裂动脉瘤患者中有1例（12.5%）接受了手术夹闭。P1-P2穿支动脉瘤主要影响中年个体（中位年龄59.5岁），14例中有10例（71.4%）为女性。血管内栓塞是总体主要治疗方式，取得了良好的技术效果，然而，有2例患者（33.3%）出现了穿支梗死，且治疗后无新的永久性致残或死亡。
P1-P2穿支动脉瘤是颅内动脉瘤的一种罕见亚型。血管内栓塞可能是一种有效的治疗方式；然而，应注意依赖穿支区域的缺血性并发症。需要更大规模的研究以提供更多见解。
