Abstract：
OBJECTIVE: Aneurysms of the posterior cerebral circulation constitute a burdensome condition with high mortality and morbidity. In the modern era, there has been a trend toward favoring an endovascular approach over microsurgery for aneurysm cases. Nevertheless, this transition has yet to be mirrored in low-to-middle-income countries where endovascular therapy may not be widely available. Herein, we aim to illustrate our experience treating these challenging conditions in patients from low-income backgrounds and discuss the relevance of the clinical setting in the treatment decision.
METHODS: The authors conducted a retrospective review of the health records of patients who received microsurgical treatment for aneurysms in the posterior circulation, including the basilar artery (BA), posterior cerebral artery (PCA), and posterior inferior cerebellar artery (PICA) in an institution providing treatment to people of low-income backgrounds. Epidemiological data, microsurgical technique, and neurological function were retrieved and analyzed.
RESULTS: Surgical clipping was employed for 12 patients (75% female) harboring 15 aneurysms (87% in the posterior circulation and 62% ruptured at presentation). Aneurysms were predominately located in the BA (69%), followed by the PCA (15%) and PICA (15%). Among neurological complications, 25% of patients developed oculomotor nerve palsy. The mortality rate was 17% owing to complications such as cerebral vasospasm, infarction, and severe intracranial hypertension. At the 6-month follow-up, 90% of patients had a good clinical outcome (modified Rankin scale scores of 0-2).
CONCLUSIONS: The present case series illustrates the manifest role of microsurgical techniques for posterior circulation aneurysms, particularly in a scenario where endovascular techniques are not easily accessible. Importantly, this clinical setting pressure could exhort trainees to strive for microsurgical mastery and gain a competitive advantage.
METHODS: The authors conducted a retrospective review of the health records of patients who received microsurgical treatment for aneurysms in the posterior circulation, including the basilar artery (BA), posterior cerebral artery (PCA), and posterior inferior cerebellar artery (PICA) in an institution providing treatment to people of low-income backgrounds. Epidemiological data, microsurgical technique, and neurological function were retrieved and analyzed.
RESULTS: Surgical clipping was employed for 12 patients (75% female) harboring 15 aneurysms (87% in the posterior circulation and 62% ruptured at presentation). Aneurysms were predominately located in the BA (69%), followed by the PCA (15%) and PICA (15%). Among neurological complications, 25% of patients developed oculomotor nerve palsy. The mortality rate was 17% owing to complications such as cerebral vasospasm, infarction, and severe intracranial hypertension. At the 6-month follow-up, 90% of patients had a good clinical outcome (modified Rankin scale scores of 0-2).
CONCLUSIONS: The present case series illustrates the manifest role of microsurgical techniques for posterior circulation aneurysms, particularly in a scenario where endovascular techniques are not easily accessible. Importantly, this clinical setting pressure could exhort trainees to strive for microsurgical mastery and gain a competitive advantage.
摘要：
目的：大脑后循环动脉瘤是一种高死亡率和高发病率的累赘疾病。在现代,对于动脉瘤病例,有一种倾向倾向于采用血管内方法而不是显微外科手术.然而，这种转变尚未在血管内治疗可能无法广泛使用的中低收入国家得到反映.在这里，我们旨在说明我们在低收入背景患者中治疗这些具有挑战性疾病的经验,并讨论临床环境在治疗决策中的相关性.
方法：作者对接受后循环动脉瘤显微外科治疗的患者的健康记录进行了回顾性回顾，包括基底动脉（BA），大脑后动脉(PCA),和小脑后下动脉（PICA）在为低收入背景的人提供治疗的机构中。流行病学数据,显微外科技术，检索并分析神经功能。
结果：12例患者（75%为女性）有15个动脉瘤（87%位于后循环，62%出现破裂）采用手术夹闭。动脉瘤主要位于BA(69%)，其次是PCA（15%）和PICA（15%）。在神经系统并发症中，25%的患者出现动眼神经麻痹。由于脑血管痉挛等并发症，死亡率为17％，梗塞,和严重的颅内高压.在6个月的随访中，90％的患者具有良好的临床结局（改良的Rankin量表评分为0-2）。
结论：本病例系列说明了显微外科技术对后循环动脉瘤的明显作用，特别是在血管内技术不容易获得的情况下。重要的是,这种临床设置压力可以激励受训者努力掌握显微外科技术并获得竞争优势。
方法：作者对接受后循环动脉瘤显微外科治疗的患者的健康记录进行了回顾性回顾，包括基底动脉（BA），大脑后动脉(PCA),和小脑后下动脉（PICA）在为低收入背景的人提供治疗的机构中。流行病学数据,显微外科技术，检索并分析神经功能。
结果：12例患者（75%为女性）有15个动脉瘤（87%位于后循环，62%出现破裂）采用手术夹闭。动脉瘤主要位于BA(69%)，其次是PCA（15%）和PICA（15%）。在神经系统并发症中，25%的患者出现动眼神经麻痹。由于脑血管痉挛等并发症，死亡率为17％，梗塞,和严重的颅内高压.在6个月的随访中，90％的患者具有良好的临床结局（改良的Rankin量表评分为0-2）。
结论：本病例系列说明了显微外科技术对后循环动脉瘤的明显作用，特别是在血管内技术不容易获得的情况下。重要的是,这种临床设置压力可以激励受训者努力掌握显微外科技术并获得竞争优势。
