背景:复杂的颅内动脉瘤(CIA)包括具有挑衅性血管结构的病变的子集,难以进入,和事先治疗。CIAs的手术管理通常具有挑战性,需要逐案评估。旁路手术的代际演变为有效的脑血管重建术提供了长期的潜力。在这里,我们的目的是说明单中心处理CIAs的经验。
方法:作者对在国家医院接受脑血管重建术治疗的患者的临床记录进行了回顾性分析,利马,秘鲁2018-2022年。收集相关数据,包括病史,动脉瘤成像特征,术前并发症,术中过程,动脉瘤闭塞率,旁路通畅,神经功能,术后并发症。
结果:纳入17例患者(70.59%为女性;中位年龄:53岁)合并17CIAs(64.7%为囊状;76.5%为破裂)。最常见的临床表现包括意识丧失(70.6%)和头痛(58.8%)。显微外科治疗包括首先,第二,和第三代旁路。在47.1%的病例中,主要使用颞上动脉(STA)和M3段之间的吻合,其次是A3-A3旁路(29.4%),STA-M2旁路(17.6%),颈外动脉转M2旁路(5.9%)。术中动脉瘤破裂率为11.8%。术后并发症包括缺血(40%),脑脊液瘘(26.7%),肺炎(20%)。出院时,格拉斯哥昏迷评分的中位数为14分(范围:10-15分).在六个月的随访中,82.4%的患者改良排序量表(mRS)评分≤2分,所有病例均存在旁路通畅,发病率为17.6%。
结论:CIA代表一系列具有不良自然史的挑衅性血管病变。旁路手术提供了最终治疗的潜力。我们的病例系列说明了CI的脑血管重建术的主要作用,以及在资源有限的情况下提供最佳结果的关键个案方法。
BACKGROUND: Complex intracranial aneurysms (CIAs) comprise a subset of lesions with defiant vascular architecture, difficult access, and prior treatment. Surgical management of CIAs is often challenging and demands an assessment on a case-by-case basis. The generational evolution of
bypass surgery has offered a long-standing potential for effective cerebral revascularization. Herein, we aim to illustrate a single-center experience treating CIAs.
METHODS: The authors conducted a retrospective analysis of clinical records of patients treated with cerebral revascularization techniques at Hospital Nacional Dos de Mayo, Lima, Peru, during 2018-2022. Relevant data were collected, including patient history, aneurysm features on imaging, preoperative complications, the intraoperative course, aneurysm occlusion rates, bypass patency, neurological function, and postoperative complications.
RESULTS: Seventeen patients (70.59% female; median age: 53 years) with 17 CIAs (64.7% saccular; 76.5% ruptured) were included. The most common clinical presentation included loss of consciousness (70.6%) and headaches (58.8%). Microsurgical treatment included first-, second-, and third-generation
bypass. In 47.1% of cases, an anastomosis between the superficial temporal artery and the M3 segment was predominantly used, followed by an A3-A3 bypass (29.4%), a superficial temporal artery-M2
bypass (17.6%), and an external carotid artery to M2
bypass (5.9%). The intraoperative aneurysm rupture rate was 11.8%. Postoperative complications included ischemia (40%), cerebrospinal fluid fistulas (26.7%), and pneumonia (20%). At hospital discharge, the median Glasgow Coma Scale score was 14 (range: 10-15). At the 6-month follow-up, 82.4% of patients had a modified Rankin Scale score ≤2,
bypass patency was present in all cases, and the morbidity rate was 17.6%.
CONCLUSIONS: CIAs represent a spectrum of defiant vascular lesions with a poor natural history.
Bypass surgery offers the potential for definitive treatment. Our case series illustrated the predominant role of cerebral revascularization of CIAs with a critical case-by-case approach to provide optimal outcomes in a limited-resource setting.