当前位置： SCI文献检索 > ACTA NEUROCHIRURGICA期刊下所有文献 > Clinical implications and radiographic characteristics of the relation between giant intracranial aneurysms of the posterior circulation and the brainstem.

Clinical implications and radiographic characteristics of the relation between giant intracranial aneurysms of the posterior circulation and the brainstem.

Abstract：

BACKGROUND:Giant intracranial aneurysms of the posterior circulation (GPCirA) are rare entities compressing the brainstem and adjacent structures. Previous evidence has shown that the amount of brainstem shift away from the cranial base is not associated with neurological deficits. This raises the question whether other factors may be associated with neurological deficits. METHODS:All data were extracted from the Giant Intracranial Aneurysm Registry, an international multicenter prospective study on giant intracranial aneurysms. We grouped GPCirA according to the mass effect on the brainstem (lateral versus medial). Brainstem compression was evaluated with two indices: (a) brainstem compression ratio (BCR) or diameter of the compressed brainstem to the assumed normal diameter of the brainstem and (b) aneurysm to brainstem ratio (ABR) or diameter of the aneurysm to the diameter of the compressed brainstem. We examined associations between neurological deficits and GPCirA characteristics using binary regression analysis. RESULTS:Twenty-eight GPCirA were included. Twenty GPCirA showed medial (71.4%) and 8 lateral compression of the brainstem (28.6%). Baseline characteristics did not differ between the groups for patient age, aneurysm diameter, aneurysm volume, modified Rankin Scale (mRS), motor deficit (MD), or cranial nerve deficits (CND). Mean BCR was 53.0 in the medial and 54.0 in the lateral group (p = 0.92). The mean ABR was 2.9 in the medial and 2.3 in the lateral group (p = 0.96). In the entire cohort, neither BCR nor ABR nor GPCirA volumes were associated with the occurrence of CND or MD. In contrast, disability (mRS) was significantly associated with ABR (OR 1.94 (95% CI 1.01-3.70; p = 0.045) and GPCirA volumes (OR 1.21 (95% CI 1.01-1.44); p = 0.035), but not with BCR. CONCLUSION:In this cohort of patients with GPCirA, neither the degree of lateral projection nor the amount of brainstem compression predicted neurological deficits. Disability was associated only with aneurysm volume. When designing treatment strategies for GPCirA, aneurysm laterality or the amount of brainstem compression should be viewed as less relevant while the high risk of rupture of such giant lesions should be emphasized. TRIAL REGISTRATION:The registry is listed at clinicaltrials.gov under the registration no. NCT02066493.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

Haemmerli J,Lenga P,Hong B,Kursumovic A,Maldaner N,Burkhardt JK,Bijlenga P,Rüfenacht DA,Schmidt NO,Vajkoczy P,Dengler J

doi

10.1007/s00701-019-04016-x

subject

Has Abstract

pub_date

2019-09-01 00:00:00

pages

1747-1753

issue

eissn

0001-6268

issn

0942-0940

pii

10.1007/s00701-019-04016-x

journal_volume

161

pub_type

临床试验,杂志文章

在线工具

Clinical implications and radiographic characteristics of the relation between giant intracranial aneurysms of the posterior circulation and the brainstem.