Shi Zhiyong, Deng Zhongren, Yu Le-Bao, Wang Yi, Hang Chunhua, Zhang Dong, Yang Yongbo
Department of Neurosurgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, Jiangsu Province, China.
Department of Neurosurgery, Huai'an Hongze District People's Hospital, HuaiAn, 223100, Jiangsu Province, China.
Neurosurg Rev. 2025 Oct 23;48(1):730. doi: 10.1007/s10143-025-03880-9.
To present results of complex intracranial aneurysms (CIAs) underwent extracranial-intracranial (EC-IC) bypass with one-stage and two-stage aneurysm trapping in anterior circulation and share our experience. The author retrospectively reviewed 53 patients with CIAs underwent EC-IC bypass with different therapies of aneurysm trapping from Jan. 2018 to Dec 2020. Ballon occlusion testing (BOT) was performed to assess collateral circulation. In general, CIAs was operated by one-stage trapping, which was characterized by simultaneous implementation of aneurysm trapping and EC-IC bypass. However, CIAs failing to BOT or harboring important perforators was performed by two-stage trapping, which involved subsequent delay in performing aneurysm trapping based on CIAs change after EC-IC bypass. Clinical variables, postoperative complications, and follow-up outcomes were presented. Of the 53 patients, 28 patients completed the one-stage aneurysm trapping, and 25 patients completed two-stage aneurysm trapping. There was significant difference in patients experiencing new cerebral infarction between patients with one-stage and two-stage aneurysm trapping (21.4% vs. 4.0%, P = 0.049). When discharged, there was significant difference in CIAs disappeared between patients with one-stage and two-stage aneurysm trapping (100.0% vs. 24.0%, P < 0.001). CIAs without one-stage aneurysm trapping achieved complex aneurysm changes after revascularization, including aneurysm disappeared, unchanged, and enlarged in 6 cases, 9 cases, and 10 cases. Out of 18 CIAs demanding two-staged aneurysm trapping, aneurysm disappeared in 17 cases and got smaller in 1 case. At the final follow-up with average of 58 months, there was no significant difference in aneurysm change between patients with one-stage and two-stage aneurysm trapping (P = 0.312). No new ischemic and hemorrhagic events developed. EC-IC bypass with one-stage aneurysm trapping was an effective option for CIAs although with high risk of operation-related infarction. EC-IC bypass with two-stage aneurysm trapping was an alternative treatment for selected CIAs.
呈现接受颅外-颅内（EC-IC）旁路手术并在前循环中进行一期和二期动脉瘤夹闭术的复杂颅内动脉瘤（CIA）的治疗结果，并分享我们的经验。作者回顾性分析了2018年1月至2020年12月期间53例行EC-IC旁路手术并采用不同动脉瘤夹闭治疗方法的CIA患者。进行球囊闭塞试验（BOT）以评估侧支循环。一般来说，CIA采用一期夹闭术，其特点是同时进行动脉瘤夹闭和EC-IC旁路手术。然而，未通过BOT或伴有重要穿支血管的CIA采用二期夹闭术，即在EC-IC旁路手术后根据CIA的变化延迟进行动脉瘤夹闭。报告了临床变量、术后并发症和随访结果。53例患者中，28例完成一期动脉瘤夹闭，25例完成二期动脉瘤夹闭。一期和二期动脉瘤夹闭患者中新发脑梗死的发生率有显著差异（21.4%对4.0%，P = 0.049）。出院时，一期和二期动脉瘤夹闭患者中CIA消失情况有显著差异（100.0%对24.0%，P < 0.001）。未进行一期动脉瘤夹闭的CIA在血运重建后出现复杂的动脉瘤变化，包括动脉瘤消失、不变和增大，分别为6例、9例和10例。在18例需要二期动脉瘤夹闭的CIA中，17例动脉瘤消失，1例变小。在平均58个月的最终随访中，一期和二期动脉瘤夹闭患者的动脉瘤变化无显著差异（P = 0.312）。未发生新的缺血性和出血性事件。尽管与手术相关的梗死风险较高，但一期动脉瘤夹闭的EC-IC旁路手术是治疗CIA的有效选择。二期动脉瘤夹闭的EC-IC旁路手术是部分CIA的替代治疗方法。
