| Background:Interventional embolization within vessels, a novel therapeutic method developed in recent years, has the characteristics of less-invasion. An increasing data suggest that decreased incidence of aneurysm rupture during surgical operation can be brought by this interventional embolization. Aneurysms in posterior circulation are also a kind of intracranial aneurysm with high morbidity, and this disease accounts for more 35 percent of intracranial cystic aneurysms. Although its morbidity and amount of bleeding due to rupturing aneurysm are inferior to that of aneurysms in anterior circulation, considering the pivotal anatomy relation, aneurysms located in the posterior circulation have the closest distance from the brainstem, as a result, a trend of higher risks damaging brainstem is found in neurosurgery for aneurysms in the posterior circulation, especially among those in deep location, leading to a significant influence on clinical prognosis of patients. Hence, adoption of interventional embolization for the aneurysms in the posterior circulation is important owing to its less-invasion and precise orientation along vessels, which gives rise prodigious prospect of this method in clinic. This study aimed to analyze and conclude the security and effectiveness of intervention embolization within vessels for the aneurysms located in the posterior circulation.Methods This was a retrospective study in-which clinical data of 91 patients with aneurysms located in the posterior circulation undergone interventional embolization from November in 2008 to March in 2015 were collected and were defined as interventional group, and diagnosis of all patients was proved by Digital Subtraction Angiography (DSA) in pre-operation. To obtain a comparison,86 patients with aneurysms located in the posterior circulation undergone traditional neurosurgery in the corresponding period were also collected. The number of patients whose aneurysms were in different location, Hunt-Hess scale, therapeutic effect, postoperative complications, and recurrence were analyzed. Indexes assessed included embolization degree. Cure, disability, and death was used as surgical effect, and the result of embolism was assessed by Cognard standard including complete embolism (embolization degree is 100%), approximatively complete embolism (embolization degree is between 90% and 100%). and incomplete embolism (embolization degree is under 90%). Postoperative follow-up was performed after 6 months to obtain the assessment of the rate of complications and recurrence.Results Embolism of 89 cases in 91 patients of interventional group were performed, whose embolism 72 cases were done by alone coil including that 54 cases with saccular aneurysms were compacted complete embolism (100%),16 cases were approximatively complete embolism (95%) and 2 cases were incomplete embolism (under 90%), and 17 cases was adopeed by stent-assisted coil including that 11 cases were complete embolism (100%),4 cases were approximatively complete embolism (95%) and 2 cases were incomplete embolism (under 90%). Another 2 cases with IV and V of Hunt-Hess scale were complicated with re-rupture in basilar artery and superior cerebellar artery after DSA examination, and accompanied with vasospasm, leading to.the operation failure resulted from disability of micro-pipe in indicated location. The patients with blurred mind and hypo-muscular tension were performed by decompressed craniotomy and hematoma was eliminated, hemorrhagic cerebrospinal fluid was also drained using lumbar puncture, and anti-vasospasm drugs were used. After active treatment, the mind of patients was sober and muscle strength was normal. There was a statistical difference between H-H classification and embolization effect (P=0.001), showing that the patients with I and II had a better effect but the patients with V had a poor effectiveness. In addition, the location of aneurysms was associated with embolization effect by Fisher exact test (P=0.003), for example, aneurysms located in the apex of basilar arteries had the highest success rate of embolization which was shown by 31 cases witfeuccessful embolization and without unsuccessful patients. In interventional group, the patients with cure were 67 cases, and the rate was 73.63%, the ones with disability were 22 cases, the rate was 24.18%, in which slight hemiplegia was 16 cases,5 patients were severe, and 1 case was persistent vegetative state, as well as 2 cases were dead, the rate was 2.2%. While, in control, the patients with successful surgery were 86 cases in which 2 cases with â…£ degree and 1 case with V were complicated with rupture in the trunk and apex of basilar artery and accompanied with sudden cloudiness, hypo-muscular tension, and positive pathological reflexes, then homeostasis, elimination of blood clot, supplement of blood volume, and correction of acidosis were immediately performed, as a result, those were significantly improved accompanied by sober mind and normal muscular tension. In this control, the patients with cure were 48 cases, the rate 55.81%, the patients with disability were 27 cases, the rate was 31.39%, and the death rate was 12.79%, which were significantly different from the interventional group (P=0.007), suggesting that the patients with adoption of interventional embolization has a good effect, as compared with the control. However, different conditions had an influence on operation results in the same surgical therapy, for instance, there was a statistical difference between varied H-H classifications and operation effect (P<0.0001), and the correlation coefficient was 0.48. As for the control, the similar results was observed revealing the more severe, the poorer effect (P<0.0001), and its coefficient was 0.460. Besides, the location of aneurysms was in relation to the efficacy of operation (P=0.008), as demonstrated by our study, a better effect was found in aneurysms located in the apex of basilar artery using interventional embolization, while a poor efficacy was observed in the posterior inferior cerebellar artery, with the lowest cure rate. Interestingly, there was no significant difference between the location of aneurysms and operation efficacy (P=0.993), and its coefficient was 0.137. In intervention group, 2 cases were blepharoptosis,2 cases were hypo-myodynamia 4 degree in left limb, and 1 case was hypo-myodynamia 4 degree in right limb, while in control with occlusion,12 cases were dysneuria including that 4 cases were hypo-myodynamia 4 degree in both upper limb,7 cases were hypo-myodynamia 4 degree in right limb,1 case was blepharoptosis,7 cases were postoperative hematoma, and 6 cases were intracranial infection, suggesting a significant difference between the two groups in the rate of complications (P<0.05) revealing that the higher rate of complication was found in the patients treated with occlusion. But for the location of aneurysms, a significant difference between location and clinical prognosis was not be found (P>0.05). Postoperative follow-up of 86 in 91 cases were performed in time, with failure of another 3 cases owing to loss of information. The 86 patients included 72 cases with coil embolization in which the effect of 54 cases were very satisfactory, recanalization of 2 cases in the neck of superior cerebellar artery aneurysms after 1 year was found meaning the recurrence of aneurysms, slight occlusion of 2 cases in the apex of the basilar artery but insufficient blood supply was not be observed, and the recurrence rate was 5.56%, and 17 cases with stent-assisted.coil embolization in which the efficacy of 11 cases were robust satisfactory shown by DSA, slight developing of 1 cases in postoperative 0.5 years was found using DSA examination implying the recurrence of aneurysms whose rate was 5.88%, all together, the total rate of recurrence for the patients with interventional embolization was 5.81%. In control, successful follow-up of 67 in 86 patients in postoperative 6 months was performed, failure of 8 cases appeared owing to the loss of information. The 67 cases included 4 cases with recurrence, whose rate was 5.97%, which was higher than that of the patients with interventional embolization, but there was no statistical significance (P=0.174).Conclusion (1) Alone coil or stent-assisted coil embolization was & safe and effective therapy for the patients with aneurysms located in the posterior circulation, especially the aneurysms in the apex of basilar artery, which can be extensively adopted in clinic.(2) The cure rate of patients treated by interventional embolization was higher than that of the patients who were treated by craniotomy.(3) Using the same approach, the effect produced by different parts of the tumor is different, such as the use of interventional embolization for the top of the basilar artery aneurysm surgery, good for anterior cerebellar artery aneurysms less effective.(4) The incidence of complications in patients treated with interventional smbolization was lower than that of the patients who were treated by craniotomy.(5) It was found that there was no significant difference in recurrence rate between the interventional embolization and clipping of the aneurysm. |
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