背景:治疗复杂的后循环动脉瘤带来了挑战,和颅外至颅内(EC-IC)旁路技术是潜在的治疗选择.然而,这种方法治疗后循环动脉瘤的安全性和有效性尚不清楚.本研究的目的是评估这些动脉瘤中EC-IC旁路的安全性和有效性。
方法:遵守PRISMA指南,我们对后循环动脉瘤的EC-IC血运重建进行了系统评价.纳入的研究至少有四名患者,并报告了死亡率数据,通畅,并发症,或临床结果。良好的临床结果定义为mRS低于3或GOS高于3,并发症是与旁路手术相关的任何问题。
结果:从审查的3,036篇文章中,选择了22项研究,涉及196例接受210例EC-IC旁路手术治疗后循环动脉瘤的患者。14项研究的中位随访期为31.66个月(6-61个月)。最终随访表明,旁路通畅率为96%[95%CI:91%-100%;I2=12%],死亡率为5%[95%CI:1%-9%;I2=0%]。此外,83%[95%CI:70%-96%;I2=77%]的患者在最后一次随访中表现出良好的结果。在40%[95%CI:26%-55%;I2=80%]中观察到并发症。异质性与特定研究相关。
结论:EC-IC旁路手术是后循环动脉瘤的可行治疗选择,具有较高的旁路通畅率和良好的临床结局。然而,并发症,尤其是神经缺陷,存在。对于处理复杂动脉瘤的神经血管外科医生来说,开放式血运重建仍然至关重要。
Treating complex posterior circulation aneurysms poses challenges, and extracranial to intracranial (EC-IC) bypass techniques are potential therapeutic options. However, the safety and efficacy of this approach for posterior circulation aneurysms remain unclear. The study\'s objective was to assess the safety and efficacy of EC-IC bypass in these aneurysms.
Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a systematic review on EC-IC revascularization for posterior circulation aneurysms. Included studies had at least 4 patients and reported data on mortality, patency, complications, or clinical outcomes. Favorable clinical outcomes were defined as modified Rankin Scale below 3 or Glasgow Outcome Scale above 3, and complications were any issues related to the bypass procedure.
From 3036 articles reviewed, 22 studies involving 196 patients who underwent 210 EC-IC bypass procedures for posterior circulation aneurysms were selected. The median follow-up period of 14 studies was 31.66 months (6-61 months). Final follow-up indicated a high bypass patency rate of 96% [95% confidence interval [CI]: 91%-100%; I2 = 12%], with a mortality rate of 5% [95% CI: 1%-9%; I2 = 0%]. Additionally, 83% [95% CI: 70%-96%; I2 = 77%] of patients showed good outcomes at the last follow-up. Complications were observed in 40% [95% CI: 26%-55%; I2 = 80%]. Heterogeneity was associated with specific studies.
EC-IC bypass procedures are a viable treatment option for posterior circulation aneurysms, with high bypass patency rates and favorable clinical outcomes. However, complications, especially neurological deficits, exist. Open revascularization remains essential for neurovascular surgeons dealing with complex aneurysms.