在已知动脉瘤的显微外科手术夹闭过程中,血管造影隐匿性(AO)动脉瘤有时会同时发现和治疗,以防止其生长并保护患者免受将来的破裂或再次手术。作者分析了发病率,治疗,以及与AO动脉瘤相关的结局,以确定在已知动脉瘤周围有限的手术探查是否安全和合理,考虑到诊断性血管造影的已知局限性.
AO动脉瘤被定义为在已知动脉瘤的解剖过程中使用手术显微镜检测到的囊状动脉瘤。在术前导管血管造影中没有检测到。回顾性审查了一个前瞻性数据库,以确定在20年内进行显微外科治疗的AO动脉瘤患者。
在2867次不同的开颅手术中,发现了115例AO动脉瘤(4.0%)。AO动脉瘤最常见的位置是大脑中动脉(60个动脉瘤,54.1%)和大脑前动脉(20个动脉瘤,18.0%)。56个AO动脉瘤(50.5%)与已知的囊状动脉瘤位于同一动脉上。大多数AO动脉瘤(95.5%)被夹闭,没有归因于发病率。血管造影检测失败的最常见原因是大动脉瘤的叠加(1型,30.6%)。小动脉瘤(2型,18.9%),或邻近的正常动脉(3型,36.9%)。多变量分析确定了多个已知动脉瘤(比值比[OR]3.45,95%置信区间[CI]2.16-5.49,p<0.0001)和年轻年龄(OR0.981,95%CI0.965-0.997,p=0.0226)作为AO动脉瘤的独立预测因子。
在另一种已知的动脉瘤的显微外科解剖中,对手术区域内常见动脉瘤部位的细致检查将识别AO动脉瘤。同时识别和治疗这些额外的未诊断的动脉瘤可以避免患者以后的破裂或再次手术。特别是那些有多个已知动脉瘤和蛛网膜下腔出血病史的患者。可以安全地在已知动脉瘤周围进行有限的显微外科手术探查,而不会增加发病率。
During the microsurgical clipping of known aneurysms, angiographically occult (AO) aneurysms are sometimes found and treated simultaneously to prevent their growth and protect the patient from future rupture or reoperation. The authors analyzed the incidence, treatment, and outcomes associated with AO aneurysms to determine whether limited surgical exploration around the known aneurysm was safe and justified given the known limitations of diagnostic angiography.
An AO aneurysm was defined as a saccular aneurysm detected using the operative microscope during dissection of a known aneurysm, and not detected on preoperative catheter angiography. A prospective database was retrospectively reviewed to identify patients with AO aneurysms treated microsurgically over a 20-year period.
One hundred fifteen AO aneurysms (4.0%) were identified during 2867 distinct craniotomies for aneurysm clipping. The most common locations for AO aneurysms were the middle cerebral artery (60 aneurysms, 54.1%) and the anterior cerebral artery (20 aneurysms, 18.0%). Fifty-six AO aneurysms (50.5%) were located on the same artery as the known saccular aneurysm. Most AO aneurysms (95.5%) were clipped and there was no attributed morbidity. The most common causes of failed angiographic detection were superimposition of a large aneurysm (type 1, 30.6%), a small aneurysm (type 2, 18.9%), or an adjacent normal artery (type 3, 36.9%). Multivariate analysis identified multiple known aneurysms (odds ratio [OR] 3.45, 95% confidence interval [CI] 2.16-5.49, p < 0.0001) and young age (OR 0.981, 95% CI 0.965-0.997, p = 0.0226) as independent predictors of AO aneurysms.
Meticulous inspection of common aneurysm sites within the surgical field will identify AO aneurysms during microsurgical dissection of another known aneurysm. Simultaneous identification and treatment of these additional undiagnosed aneurysms can spare patients later rupture or reoperation, particularly in those with multiple known aneurysms and a history of subarachnoid hemorrhage. Limited microsurgical exploration around a known aneurysm can be performed safely without additional morbidity.