目的:本研究的目的是描述在介入治疗时代开放手术治疗基底动脉动脉瘤的有效性和评估,包括手术夹闭和血液重建,回顾性分析本中心基底动脉动脉瘤的临床资料。
方法:根据纳入和排除标准,回顾性纳入在我们中心接受治疗的基底动脉动脉瘤患者。基本临床资料,手术方法,对入选患者的临床随访情况和预后进行详细分析.在这项研究中,mRS评分用于评估患者的神经系统预后,用SPSS对相关数据进行统计学分析。
结果:本研究纳入了2010年1月至2023年8月在我们中心接受治疗的104名合格患者,其中67例通过开放手术治疗,37例通过旁路手术治疗。对于67例开放性手术夹闭患者,平均年龄为60.0(52.0,65.0)岁.动脉瘤的最大直径范围为2.0mm至54.0mm,平均值为13.9(10.0,19.0)mm。平均随访时间38(20,58)个月。在最后一次随访中,发现61个(91.0%)完全闭塞的动脉瘤和6个(9.0%)不完全闭塞的动脉瘤。59例(88.1%)患者预后良好,8例(11.9%)患者预后差。手术夹闭后,术后动脉瘤完全消除和不完全消除在预后良好组和预后不良组之间差异有统计学意义(P<0.001).对于37名搭桥组患者,平均年龄为52.0(45.5,59.0)岁.动脉瘤的最大直径范围为10.5mm至55.0mm,平均值为28.55±12.08mm。18例(48.6%)患者行搭桥联合近端闭塞术,19例(51.4%)患者仅进行了旁路手术.临床随访19.0(10.5、43.0)个月。有19例(51.4%)患者完全消除了动脉瘤,13(35.1%),动脉瘤消除不完全,5(13.5%)动脉瘤稳定。32例(86.5%)患者预后良好,5例(13.5%)患者预后较差。
结论:基底动脉动脉瘤的治疗具有挑战性。在快速发展的介入治疗时代的背景下,对于不适合介入的复杂基底动脉动脉瘤,包括手术夹闭和搭桥是理想的选择。
OBJECTIVE: The purpose of this study was to describe the effectiveness and evaluation of open surgical treatment of basilar artery aneurysms in the context of interventional therapy era, including surgical clipping and blood reconstruction, by retrospectively analyzing the clinical data of basilar artery aneurysms in our center.
METHODS: Patients with basilar artery aneurysms who were treated at our center were retrospectively included according to the inclusion and exclusion criteria. The basic clinical data, surgical approach, clinical follow-up and prognosis of the enrolled patients were analyzed in detail. In this study, the mRS score was applied to assess the neurological prognosis of the patients, and the relevant data were statistically analyzed using SPSS.
RESULTS: A total of 104 eligible patients treated at our center from January 2010 to August 2023 were included in this study, of which 67 were treated by open surgery and 37 by
bypass. For the 67 patients with open surgical clipping, the mean age was 60.0 (52.0, 65.0) years. The maximum diameter of the aneurysms ranged from 2.0 mm to 54.0 mm, with a mean of 13.9 (10.0, 19.0) mm. The mean follow-up time was 38 (20, 58) months. At the last follow-up, 61 (91.0%) completely obliterated aneurysms and 6 (9.0%) incompletely obliterated aneurysms were found. The prognosis was good in 59 (88.1%) patients and poor in 8 (11.9%). After surgical clipping, the difference between complete and incomplete postoperative aneurysm elimination was statistically significant between the favorable and poor prognosis groups (P < 0.001). For the 37
bypass group patients, the mean age was 52.0 (45.5, 59.0) years. The maximum diameter of the aneurysm ranged from 10.5 mm to 55.0 mm, with a mean of 28.55 ± 12.08 mm.
Bypass combined with proximal occlusion was performed in 18 (48.6%) patients, and
bypass only was performed in 19 (51.4%) patients. Clinical follow-up was 19.0 (10.5, 43.0) months. There were 19 (51.4%) patients with complete elimination of the aneurysm, 13 (35.1%) with incomplete elimination of the aneurysm, and 5 (13.5%) with aneurysm stabilization. The prognosis was good in 32 (86.5%) patients and poor in 5 (13.5%) patients.
CONCLUSIONS: Treatment of basilar artery aneurysms is challenging. In the context of the rapidly evolving interventional therapy era, open surgery including surgical clipping and
bypass is an ideal option for complex basilar artery aneurysms not amenable to intervention.