| OBJECTIVE1. To summarize the characteristics of configuration, distribution and clinical manifestations of cerebral aneurysms located in the posterior circulation.2. To preliminarily evaluate the safety and validity of open surgery and endovascular treatment in posterior circulation cerebral aneurysms and to see which is more suitable to us.MATERIALS AND METHODS1. From November 1992 to November 2009,56 patients with 57 posterior circulation cerebral aneurysms were treated with neurosurgical approach in Neurosurgical Department of Shandong Provincial Hospital Affiliated to Shandong University. We itemized the configuration, distribution and clinical manifestations of the 57 aneurysms and analyzed the data we got retrospectively.2.18 patients with 18 aneurysms were sliced open with an average age 46.1, the 18 aneurysms consist of 7 located in the basilar artery,6 in the vertebral artery,5 in the posterior cerebral artery; The Hunt-Hess grade at presentation of the 18 patients was 0 in 2 patients,â… in 3,â…¡in 9,â…¢in 3,â…£in 1 patient.7 of the aneurysms were giant,4 was large,6 was medium,1 was small-sized.38 patients with 39 aneurysms were coiled with an average age 48.5, the 39 aneurysms consist of 17 located in the basilar artery, 17 in the vertebral artery,5 in the posterior cerebral artery; The Hunt-Hess grade at presentation of the 38 patients was 0 in 4 patients,â… in 6,â…¡in 16,â…¢in 9,â…£in 3 patients.2 aneurysms were large,22 was medium,15 was small-sized. The complications, short-term prognosis, length of stay and recurrence of the two groups were compared. Statistical analysis was performed with X2 test and t test.RESULTS1.The morbidity of posterior circulation cerebral aneurysms is by far smaller than anterior circulation cerebral aneurysms, they only account for 9.1% of all the intracranial aneurysms.Posterior circulation cerebral aneurysm often presents a SAH when onset (80.3%).There were mainly saccular aneurysms and fusiform aneurysms located in posterior cerebral circulation with an incidence 94.6%.Giant and large aneurysms were often seen in the posterior cerebral circulation (23%).2.(1)There were 8 patients who were sliced open developed complications and the incidence was 44.4%;4 patients who were coiled developed complications and the incidence was 10.5%.The difference between the two groups was statistically obvious(continuity correction x2=6.453,P=0.0110.05) and the incidence of complications of endovascular occlusion is lower.(2)7 patients who were sliced open were evaluated with a poor short-term prognosis at discharge and the incidence was 38.9%; while 3 cases who were coiled were evaluated a short-term poor prognosis at discharge and the incidence was7.9%. The difference between the two groups was obvious(continuity correction X2=6.026,P=0.014<0.05),the short-term prognosis of endovascular occlusion is better.(3) 2 patients who were sliced open were dead in hospital with the mortality of 11.1%, 1 patient died in the other group, the mortality is 2.6%.The difference between the two groups were not statistically obvious(continuity correction x2=0.463,P=0.486>0.05);.(4)The average length of stay were respectively 20.55 and 14.28 days, and the difference between two groups were statistically obvious(t=3.70,P=0.00<0.05); apparently, patients who were coiled stayed much shorter than the others.(5)There were respectively 14 and 29 patients coming back for a review check in group of open surgery and endovascular treatment, only one case with endovascular treatment relapsed(another patient who was coiled developed a new aneurysm in anterior circulation). The recurrence rates were respectively 0 and 2.6%,.Both are very low. The difference between the recurrence rate of the two groups were not statically obvious(continuity correction x2=0.00, P= 1.000.05).CONCLUSIONS1. Posterior circulation cerebral aneurysms show a lot of characteristics in the configuration, distribution and clinical manifestations.2. The endovascular occlusion is a better way to treat posterior circulation cerebral aneurysms with a low incidence of complications, a better prognosis and much shorter length of stay. The differences of mortality and recurrence rate between the two groups were not statistically obvious. But a long-time follow up is still in need.
|
PDF Full Text Request