Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan; Department of Neurosurgery, Tokorozawa Mihara General Hospital, Tokorozawa-shi, Saitama, Japan.
Clin Neurol Neurosurg. 2024 Dec;247:108630. doi: 10.1016/j.clineuro.2024.108630. Epub 2024 Nov 6.
This study aimed to clarify the risk factors for postoperative cerebral infarction in surgical clipping for prevalent small middle cerebral artery aneurysms (MCA Ans).
This retrospective study included 246 patients (mean age, 64.8 ± 10.0 years; 25.6 % males, 74.4 % females) with 258 aneurysms (mean aneurysm size, 5.4 ± 2.4 mm) who underwent direct surgery for unruptured MCA Ans at our institution from January 2015 to December 2020. All surgeries were performed under general anesthesia, incorporating indocyanine green videoangiography and transcranial motor-evoked potentials to enhance surgical precision and safety. The occurrence of surgery-related cerebral infarction was evaluated using postoperative CT scans within one week, comparing them with preoperative images. Patients were categorized based on the presence or absence of postoperative stroke and were analyzed for age, sex, past medical history, aneurysm size, number of clips used, and distance from the midline to the aneurysm.
Seventeen patients had postoperative cerebral infarction (6.6 %, symptomatic 6, asymptomatic 11). There were no significant differences in terms of age, number of clips, or aneurysm size between the two groups; however, the distance from the midline to the aneurysm was significantly shorter in the stroke group (27.1 ± 4.7 mm; p < 0.001), with a cutoff value of 29 mm using the receiver operating characteristic curve.
Surgical clipping for MCA Ans presents a high risk of cerebral infarction for aneurysms located closer to the midline, emphasizing the importance of considering aneurysm location as a risk indication in surgical clipping.
本研究旨在阐明手术夹闭常见小型大脑中动脉动脉瘤（MCA Ans）后发生脑梗死的危险因素。
本回顾性研究纳入了 2015 年 1 月至 2020 年 12 月在我院接受直接手术治疗未破裂 MCA Ans 的 246 例患者（平均年龄 64.8 ± 10.0 岁；25.6%为男性，74.4%为女性），共 258 个动脉瘤（平均动脉瘤大小 5.4 ± 2.4mm）。所有手术均在全身麻醉下进行，术中采用吲哚菁绿血管造影和经颅运动诱发电位，以提高手术精度和安全性。通过术后 1 周内的 CT 扫描评估手术相关脑梗死的发生情况，并与术前图像进行比较。根据术后是否发生卒中对患者进行分类，并对年龄、性别、既往病史、动脉瘤大小、夹闭的数量和动脉瘤与中线的距离进行分析。
17 例患者发生术后脑梗死（6.6%，症状性 6 例，无症状性 11 例）。两组间年龄、夹闭的数量或动脉瘤大小无显著差异；然而，卒中组的动脉瘤与中线的距离明显更近（27.1 ± 4.7mm；p<0.001），ROC 曲线的截断值为 29mm。
MCA Ans 手术夹闭对于靠近中线的动脉瘤发生脑梗死的风险较高，这强调了在手术夹闭中考虑动脉瘤位置作为风险指标的重要性。
