PDF(Pubmed)
Abstract：
Our study aimed to evaluate the postoperative outcome of patients with unruptured giant middle cerebral artery (MCA) aneurysm revealed by intracranial hypertension associated to midline brain shift. From 2012 to 2022, among the 954 patients treated by a microsurgical procedure for an intracranial aneurysm, our study included 9 consecutive patients with giant MCA aneurysm associated to intracranial hypertension with a midline brain shift. Deep hypothermic circulatory flow reduction (DHCFR) with vascular reconstruction was performed in 4 patients and cerebral revascularization with aneurysm trapping was the therapeutic strategy in 5 patients. Early (< 7 days) and long term clinical and radiological monitoring was done. Good functional outcome was considered as mRS score ≤ 2 at 3 months. The mean age at treatment was 44 yo (ranged from 17 to 70 yo). The mean maximal diameter of the aneurysm was 49 mm (ranged from 33 to 70 mm). The mean midline brain shift was 8.6 mm (ranged from 5 to 13 mm). Distal MCA territory hypoperfusion was noted in 6 patients. Diffuse postoperative cerebral edema occurred in the 9 patients with a mean delay of 59 h and conducted to a postoperative neurological deterioration in 7 of them. Postoperative death was noted in 3 patients. Among the 6 survivors, early postoperative decompressive hemicraniotomy was required in 4 patients. Good functional outcome was noted in 4 patients. Complete aneurysm occlusion was noted in each patient at last follow-up. We suggest to discuss a systematic decompressive hemicraniotomy at the end of the surgical procedure and/or a partial temporal lobe resection at its beginning to reduce the consequences of the edema reaction and to improve the postoperative outcome of this specific subgroup of patients. A better intraoperative assessment of the blood flow might also reduce the occurrence of the reperfusion syndrome.
摘要：
我们的研究旨在评估与中线脑移位相关的颅内高压显示的未破裂巨大大脑中动脉（MCA）动脉瘤患者的术后预后。从2012年到2022年，在接受颅内动脉瘤显微外科手术治疗的954例患者中，我们的研究纳入了9例与颅内压增高相关的巨大MCA动脉瘤伴中线脑移位的连续患者.4例患者进行了深低温循环流量减少（DHCFR）血管重建，5例患者采用动脉瘤捕获的脑血管重建术。进行早期（<7天）和长期临床和放射学监测。3个月时mRS评分≤2，认为功能预后良好。治疗时的平均年龄为44岁(范围为17至70岁)。动脉瘤的平均最大直径为49mm（范围为33至70mm）。平均中线脑移位为8.6mm（范围从5到13mm）。在6例患者中发现了远端MCA区域灌注不足。9例患者发生弥漫性术后脑水肿，平均延迟59小时，其中7例发生术后神经功能恶化。术后死亡3例。在6名幸存者中，4例患者需要术后早期去骨瓣减压术。4例患者的功能转归良好。在最后一次随访时，每位患者均发现动脉瘤完全闭塞。我们建议在外科手术结束时讨论系统的减压性半切开术和/或在开始时进行颞叶部分切除术，以减少水肿反应的后果并改善该特定亚组患者的术后预后。更好的术中血流评估也可能减少再灌注综合征的发生。
