Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.
Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
Neurosurg Rev. 2024 Oct 1;47(1):707. doi: 10.1007/s10143-024-02875-2.
Treating complex posterior cerebral artery (PCA) aneurysms, such as fusiform, giant, and dissecting aneurysms, poses significant challenges. Parent artery occlusion carries a risk of ischemic stroke and fails to alleviate mass effects. This study aims to analyze the technical nuances and patient outcomes of treating complex PCA aneurysms, ranging from the P1 to P2P segments, using a Zygomatic Anterolateral Temporal Approach(ZATA) combined with flow reconstruction. This study was a retrospective study. Surgical treatment was performed on twelve patients with complex PCA aneurysms located in the P1 to P2P segments. Ten patients underwent flow reconstruction including Superficial Temporal Artery(STA)-Middle Cerebral Artery(MCA),Internal Maxillary Artery(IMA)-Radial Artery(RA)-MCA,STA-PCA(P2), and IMA-RA-PCA(P2). The aneurysm occlusion rate, surgical complications, and patient prognosis, including stroke occurrence/ modified Rankin Scale(mRS), were recorded and analyzed. Using the ZATA, all twelve complex PCA aneurysms were successfully clipped/resected/trapped. This included two high-position aneurysms (> 3 mm above the posterior clinoid process) at the P1/P2 junction and three P2P aneurysms. The mass effects of six large or giant aneurysms were resolved or alleviated. Postoperative and follow-up CTA/DSA confirmed the patency of the bypass vessels. Four patients experienced strokes in the perioperative period, with three ischemic and one hemorrhagic. The median follow-up period was 28.5 months. At the last follow-up, the good prognosis rate (mRS ≤ 2) was 83.3%, and one patient had died. Clipping/resection/trapping of aneurysms via the ZATA, combined with flow reconstruction, is a feasible option for treating complex PCA aneurysms from the P1 to P2P segments. This approach helps maintain or improve cerebral perfusion in the affected vascular territory.
治疗复杂的大脑后动脉（PCA）动脉瘤，如梭形、巨大和夹层动脉瘤，具有很大的挑战性。主干动脉闭塞会导致缺血性中风的风险，且无法减轻占位效应。本研究旨在分析使用颧骨前外侧颞下入路（ZATA）结合血流重建治疗复杂 PCA 动脉瘤的技术细节和患者预后，动脉瘤位于 P1 至 P2P 段。这是一项回顾性研究。对 12 例位于 P1 至 P2P 段的复杂 PCA 动脉瘤患者进行了手术治疗。其中 10 例行血流重建，包括颞浅动脉（STA）-大脑中动脉（MCA）、内上颌动脉（IMA）-桡动脉（RA）-MCA、STA-PCA（P2）和 IMA-RA-PCA（P2）。记录并分析了动脉瘤闭塞率、手术并发症和患者预后，包括卒中发生/改良 Rankin 量表（mRS）评分。使用 ZATA，成功夹闭/切除/困住了所有 12 例复杂 PCA 动脉瘤。这包括 2 例位于 P1/P2 交界处的高位动脉瘤（高于后床突 3mm 以上）和 3 例 P2P 动脉瘤。6 例大或巨大动脉瘤的占位效应得到解决或缓解。术后和随访 CTA/DSA 证实了旁路血管的通畅性。4 例患者在围手术期发生卒中，其中 3 例为缺血性，1 例为出血性。中位随访时间为 28.5 个月。末次随访时，良好预后率（mRS≤2）为 83.3%，1 例患者死亡。ZATA 结合血流重建夹闭/切除/困住动脉瘤是治疗 P1 至 P2P 段复杂 PCA 动脉瘤的一种可行方法。该方法有助于维持或改善受累血管区域的脑灌注。
