Azab Mohammed A, Mostafa Hamid Abdelma'aboud, Attalah Oday
Department of Neurosurgery, Cairo University Hospital, Egypt.
Faculty of Medicine, Al-Azhar University, Egypt.
Neuroradiol J. 2024 Dec 10:19714009241303130. doi: 10.1177/19714009241303130.
Perianeurysmal edema occurring after endovascular treatment for cerebral aneurysms is uncommon compared to surgical clipping. The clinical aspects and the exact explanation are poorly understood.
We searched PubMed, Google Scholar, and Web of Science. We used the following keywords: "endovascular management of cerebral aneurysms," "perianeurysmal cerebral edema," "perianeurysmal cerebral edema after endovascular treatment endovascular treatment," "intracranial aneurysms with perianeurysmal edema," and "vessel wall enhancement after endovascular therapy." For each case, demographic, clinicopathological, therapeutic, and follow-up data were gathered and analyzed.
Perianeurysmal edema after endovascular treatment has a clear female predilection, with a male: female ratio of 12:29 (25%; 60.41%). The average time from EVT to the onset of edema ranged from 1 day to about 8 years. The aneurysm dimension ranged from 6.8 to 25 mm as the largest size reported. Most patients were asymptomatic (18 [37.5 %]), and headache was the presenting symptom in 10 patients (20.8%). Aneurysmal wall enhancement was reported in 16 (33.3 %) patients with perianeurysmal edema. About 12 patients (25%) developed post-EVT hydrocephalus. The most common coil used was the platinum type (31 [64.58%]). Most of the patients were treated expectantly with follow-up (17 [35.41 %]), while steroids were used only in 14 (29.16%) patients. Most of the patients have their edema resolved (29 [60.41%]) or stable (9 [37.5%]).
There is growing evidence supporting the incidence of post-embolization inflammatory reactions involving the vessel wall and the surrounding parenchyma; however, the exact clinical perspectives and the predisposing factors are not fully uncovered. This analysis highlights the possible presentations and short-term outcome of patients presenting with perianeurysmal edema after endovascular management of cerebral aneurysms.
与外科夹闭术相比，脑动脉瘤血管内治疗后发生的瘤周水肿并不常见。其临床情况及确切原因尚不清楚。
我们检索了PubMed、谷歌学术和科学网。我们使用了以下关键词：“脑动脉瘤的血管内治疗”、“瘤周脑水肿”、“血管内治疗后脑瘤周水肿”、“伴有瘤周水肿的颅内动脉瘤”以及“血管内治疗后的血管壁强化”。收集并分析了每例患者的人口统计学、临床病理、治疗及随访数据。
血管内治疗后的瘤周水肿明显以女性居多，男女比例为12:29（25%；60.41%）。从血管内治疗到水肿出现的平均时间为1天至约8年。报告的动脉瘤最大尺寸范围为6.8至25毫米。大多数患者无症状（18例[37.5%]），10例患者（20.8%）以头痛为首发症状。16例（33.3%）有瘤周水肿的患者报告有动脉瘤壁强化。约12例患者（25%）发生血管内治疗后脑积水。最常用的栓塞圈类型为铂类（31例[64.58%]）。大多数患者接受保守治疗并随访（17例[35.41%]），而仅14例患者（29.16%）使用了类固醇。大多数患者的水肿消退（29例[60.41%]）或稳定（9例[37.5%]）。
越来越多的证据支持栓塞后涉及血管壁和周围实质的炎症反应的发生率；然而，确切的临床情况和易感因素尚未完全明确。本分析强调了脑动脉瘤血管内治疗后出现瘤周水肿患者的可能表现及短期预后。
