背景:大脑中动脉(MCA)动脉瘤的主要通路是经侧裂入路。尽管已经评估了西尔维安裂隙(SF)变异,没有人检查这如何影响MCA动脉瘤手术。这项研究的目的是研究SF变异如何影响手术治疗的未破裂MCA动脉瘤的临床和放射学结果。
方法:这项回顾性研究检查了101例接受SF夹层和动脉瘤夹闭的患者中连续未破裂的MCA动脉瘤。SF解剖变异使用新的功能解剖分类进行分类:I型:宽直,II型:广泛的额叶和/或颞叶疝,III型:窄直,IV型:狭窄的额叶和/或颞叶疝。SF变异与术后水肿的关系,缺血,出血,血管痉挛,并对格拉斯哥预后量表(GOS)进行分析。
结果:研究包括101名患者(53.5%女性),60.9±9.4(范围24-78)年。SF类型为29.7%,I型,19.8%II型,35.6%III型,14.9%第四类。女性比例最高的SF型为IV型(n=11,73.3%),而男性为III型(n=23,63.9%)(p=0.03)。SF类型之间存在显着差异,缺血和水肿(分别为p<0.001,p=0.008)。尽管窄SF类型的GOS评分较差(p=0.055),SF类型和GOS之间没有显着差异,术后出血,血管痉挛,或住院。
结论:Sylvian裂变异可能影响动脉瘤手术的术中并发症。因此,术前确定SF变体可以预测手术困难,从而潜在地降低MCA动脉瘤和其他需要SF夹层的病理患者的发病率。
The main access route for middle cerebral artery (MCA) aneurysms is the transsylvian approach. Although Sylvian fissure (SF) variations have been assessed, none have examined how this affects MCA aneurysm surgery. The objective of this study is to investigate how SF variants affect clinical and radiological outcomes for surgically-treated unruptured MCA aneurysms.
This retrospective study examined consecutive unruptured MCA aneurysms in 101 patients undergoing SF dissection and aneurysm clipping. SF anatomical variants were categorized using a novel functional anatomical classification: Type I: Wide straight, Type II: Wide with frontal and/or temporal opercula herniation, Type III: Narrow straight, and Type IV: Narrow with frontal and/or temporal opercula herniation. The relationships between SF variants and postoperative edema, ischemia, hemorrhage, vasospasm, and Glasgow Outcome Scale (GOS) were analyzed.
Study included 101 patients (53.5% women), 60.9 ± 9.4 (range 24-78) years. SF types were 29.7% Type I, 19.8% Type II, 35.6% Type III, and 14.9% Type IV. The SF type with the highest proportion of females was Type IV (n = 11, 73.3%), while it was Type III for males (n = 23, 63.9%) (P = 0.03). There were significant differences between SF types, ischemia, and edema (P < 0.001, P = 0.008, respectively). Although narrow SF types had poorer GOS scores (P = 0.055), there were no significant differences between SF types and GOS, postoperative hemorrhage, vasospasm, or hospital stay.
Sylvian fissure variants may impact intraoperative complications during aneurysm surgery. Thus, presurgical determination of SF variants can predict surgical difficulties, thereby potentially reducing morbidity for patients with MCA aneurysms and other pathologies requiring SF dissection.