Therapeutic Effectiveness Of Revascularization Treatment For Complex Intracranial Aneurysms

Objective:1.To analyze the information of complex anterior circulation aneurysms,find out the technical characters of revascularization in the treatment of complex anterior circulation aneurysms,evaluate the efficiency of revascularization in the treatment of complex anterior circulation aneurysms.2.To analyze the information of complex proximal posterior inferior cerebellar artery(PICA)aneurysms,find out the technical characters of revascularization in the treatment of complex proximal PICA aneurysms,evaluate the efficiency of revascularization in the treatment of complex proximal PICA aneurysms.Methods:1.A retrospective analysis was conducted on 24 cases of complex anterior circulation aneurysms(29 aneurysms)who were admitted to Neurosurgical Department of Tianjin Huanhu Hospital from August 2011 to April 2017.According to the different position of aneurysms,different ways of revascularization were underwent.8 cases were treated with internal carotid artery(ICA)occlusion and superficial temporal artery(STA)-middle cerebral artery(MCA)anastomosis.ICA constriction and STA-MCA anastomosis was performed in 2 cases.External carotid artery(ECA)-radial artery(RA)-MCA anastomosis was performed in 8 cases,MCA aneurysm resection and RA in situ anastomosis in 4 cases,2 cases of internal maxillary artery(IMA)-RA-MCA anastomosis + aneurysm trapping.The patency of the anastomotic vessels and postoperative complications were observed and the patients’ prognosis are evaluated with modified Rankin scale(mRS).2.A retrospective analysis was conducted on 10 cases of complex proximal PICA aneurysms(10aneurysms)who were admitted to Neurosurgical Department of Tianjin Huanhu Hospital from June 2008 to January 2018.According to the morphological characteristics and collateral circulation of aneurysms,different ways of revascularization were underwent.8 cases were treated with occipital artery(OA)-PICA anastomosis + aneurysms trapping;vertebral artery(VA)occlusion and OA-PICA anastomosis was performed in 1 case,aneurysm depression and PICA in situ anastomosis was performed in 1 case.The patency of the anastomotic vessels and postoperative complications were observed and the patients’ prognosis are evaluatedwith modified Rankin scale(mRS).Results:1.All the 24 cases were successfully completed the blood flow reconstruction,6 cases had cerebral infarction after anastomosis,and 1 case died of massive cerebral infarction.23 cases were followed up effectively.The follow-up period was 3-68 months after operation.No recurrent or ruptured aneurysms were found in the follow-up period.1 cases died because of large area cerebral infarction.5 cases of cerebral infarction resulted in aphasia and hemiplegia,1 cases died after 2 years,and the rest 4 cases recovered after rehabilitation treatment.The score of mRS was 0 in 18cases(78.3%),1 in 3 cases(13.1%),3 in 1 case(4.3%)and 6 in 1 case(4.3%).2.10 complex proximal PICA aneurysms cases were successfully completed the blood flow reconstruction.2 cases had hoarseness after operation,and fully recovered to normal after treatment.1 patient developed dyspnea and pulmonary infection 3 days after operation,and fully recovered to normal after treatment.10 cases were followed up effectively.The follow-up period was 3-118 months after operation.No recurrent or ruptured aneurysms were found in the follow-up period,1 case died of cerebral hemorrhage because of hypertension pressure after 12 months,ventriculoperitoneal drainage was performed in 1 case of hydrocephalus.9 cases of the anastomotic vessels were patent and 1 case were occlusion.all aneurysms were dissappeared.The score of mRS was 0 in 8 cases,1 in 1 case and 6 in 1 case.Conclusion:1.Depending on the location of the complex anterior circulation aneurysm and the collateral circulation,different revascularization techniques are selected.Appropriate revascularization is an effective method for the treatment of complex anterior circulation aneurysms.2.Depending on the morphological characteristics and collateral circulation,appropriate revascularization is an effective method for the treatment of complex proximal posterior inferior cerebellar artery aneurysms.