| Objective:To investigate the methods,timing and complications of clipping treatment of posterior communicating artery aneurysms,and to discuss the treatment of ruptured aneurysms and multiple aneurysms during operation.The atherosclerosis and calcification of the parent artery and the aneurismal neck are divided into Types I-III which can guide the aneurysm clipping operation strategy,assist with choosing the clips and can help in predicting the occurrence of rupture and hemorrhaging,as well as aid in determining the prognosis for intraoperative aneurysms.Materials and Methods: Altogether,data on 136 patients with PCo A aneurysms associated with atherosclerosis and calcification who were admitted to the Department of Neurosurgery,The First Hospital of Jilin University,from January 2013 to June 2016 were continuously collected in this study.Preoperative scoring,clipping treatment,prognosis analysis,follow-up were performed and statistical analysis was done.Results: According to the classification of arteriosclerosis and calcification,among the 136 cases of PCo A aneurysms,4 were Type I(3.0%),86 were Type II(63.2%),and 46 were Type III(33.8%).The aneurysm diameters ranged from 1.7 to 11.8 mm(5.9±2.5 mm)(Type ?,6.2±3.5 mm;Type II,5.8±2.5 mm;Type III,6.0±2.4 mm).The t tests wereused,no statistically significant difference in diameters was observed among Type I and Type II aneurysms(P=0.59,>0.05),Type II and Type III aneurysms(P=0.19,>0.05),Type I and Type III aneurysms(P>0.05),Please refer to Table I and II.Among the 136 cases,131 involved single PCo A aneurysms(96.3%),and 5 cases involved multiple aneurysms in other locations(3.7%).The anterior clinoid process was resected epidurally or intradurally before aneurysm clipping to reveal the presence of the parent artery and aneurysm neck in 2 cases.Among the 136 cases,there were 5 of multiple aneurysms,which were clipped at the same time.An aneurysm clip was used in 114 cases(83.8%),and more than 2 aneurysm clips were used for occlusion in 22 cases(16.2%)of PCo A aneurysms.An attempt to temporarily block the parent artery was always made in the process of aneurysm clipping.The temporary occlusion of the parent artery was successfully performed in the 4 Type I cases,41 of the 86 Type II cases(47.7%,41/86),and 22 of the 46 Type III cases(47.8%,22/46).There was no statistically significant difference between Type II and Type III cases in the number of arteries that were successfully temporarily occluded while treating aneurysms(P>0.05).No intraoperative aneurysm rupture was seen in the 4 cases of Type I atherosclerosis and calcification;among the 86 Type II cases,intraoperative rupture occurred in 5(5.8%,5/86),and among the 46 Type III cases,intraoperative rupture occurred in 11(23.9%,11/46).There wasa statistically significant difference in the incidence of intraoperative rupture between the Type II and Type III cases(P<0.05).Fenestrated clips were not used in the 4 Type I cases during aneurysm clipping.Among the 86 Type II cases,fenestrated clips were used in 11(12.8%,11/86),and among the 46 Type III cases,fenestrated clips were used in 13(28.3%,13/46).There was a statistically significant difference in the use of fenestrated aneurysm clips between the Type II and Type III cases(P<0.05).After aneurysm clipping,the 4 Type I cases did not exhibit complications.Among the 86 Type II cases,9(10.5%,9/86)got worse postoperatively,and among the 46 Type III cases,11(23.9%,11/46)got worse postoperatively.There was a statistically significant difference in the number of patients that got worse postoperatively between the Type II and Type III cases(P<0.05).CTA follow-up was performed at 3-6 months postoperatively.Among the 136 cases,120(88.2%,120/136)were followed up with CTA.The results showed that the aneurysms were completely closed without recurrence.At 6 months to 1 year,a telephone follow-up was performed in most patients(97.1%,132/136).The GOS scores were as follows: 126 patients(95.5%,126/132)achieved a score of 5;4 patients(3%,4/132)achieved a score of 4;and 2 patients(1.5%,2/132)achieved a score of 3.Conclusions: 136 cases of clipping surgeries for PCo A aneurysms accompanied by atherosclerosis and calcification were described in thisstudy.It was found that classification of the extent of atherosclerosis and calcification of the parent artery and aneurysm neck into Types I-III can guide the aneurysm clipping operation strategy,assist with choosing the clips and can help in predicting the occurrence of rupture and hemorrhaging,as well as aid in determining the prognosis for intraoperative aneurysms. |
PDF Full Text Request