Microsurgical Clipping Techniques And Perioperative Evaluation Of Posterior Communicating Artery Aneurysms: A Single-center Retrospective Analysis

Background: Posterior communicating artery aneurysms are a common type of intracranial aneurysms with a high incidence,accounting for 15-25% of all patients with intracranial aneurysms and 50% of those originating from the internal carotid artery.Compared with other intracranial aneurysms,posterior communicating artery aneurysms are easier to rupture and have a higher recurrence rate after treatment.In clinical manifestations,except for the oculomotor nerve paralysis caused by the space occupying effect of the aneurysm on the oculomotor nerve,patients rarely show clinical symptoms before aneurysm rupture.Microsurgical clipping is a mature and widely used surgical method,and the curative effect of microclipping is further improved after the combined application of intraoperative monitoring techniques such as neuroelectrophysiological monitoring,vascular ultrasound monitoring,indocyanine green fluorescence angiography and so on.Objective: 1.To summarize the epidemiological and imaging features of patients with posterior communicating artery aneurysms.2.To explore the risk factors related to poor prognosis after clipping in the imaging data of aneurysms and the general condition of the patients before operation.3.To explore the relationship between risk factors related to poor prognosis;4.To summarize the main points of clipping posterior communicating artery aneurysms.Methods: A retrospective study included 820 patients with posterior communicating artery aneurysms treated by Professor Yugong Feng from January 1,1996 to December 31,2022(749 patients with single posterior communicating artery aneurysms and 71 patients with posterior communicating artery aneurysms).According to the results of discharge evaluation,the patients were divided into four states: rehabilitation,self-care,severe disability or vegetative survival state and death.Plant survival status and death were defined as poor prognosis.The general data,imaging features,intraoperative rupture and postoperative complications of the patients were collected.In patients with single posterior communicating artery aneurysm,the epidemiological characteristics and morphological characteristics of aneurysms were analyzed,and the factors related to poor prognosis were explored by univariate and multivariate logistic regression analysis.To explore the relationship between risk factors related to poor prognosis.Results: Of the 820 patients,749 patients with single posterior communicating artery aneurysm were male(19.0%)and female(81.0%).The average age of female was 60.1years old,the average age of male was 57.2 years old,and the contrast between left and right side of aneurysm was 349%(46.6%).The majority of patients originated from the back of the angle of ICA-PCOA(567 cases,75.7%),while 18.7% of the patients originated from the lateral wall of PCOA accounted for 5.6% of the patients near the beginning of PCOA.There were 230 small aneurysms(30.7%),431 medium aneurysms(57.6%),82 large aneurysms(10.9%)and 6 giant aneurysms(0.8%).There were 30patients(4.0%)with poor prognosis after operation.Among the 71 patients with postmirror communicating artery aneurysms,the ratio of male to female was 5.6%,94.4%,with the largest proportion of patients over 60 years old(60.6%),and 1.4% of patients aged 20-39 years old accounted for 38.0% of 40-59 years old patients.In 69 patients with ruptured aneurysms,the statistical results of ruptured aneurysms are as follows: small aneurysms account for 30.4%,medium-sized aneurysms account for 59.4%,large aneurysms account for 8.7%,and giant aneurysms account for 1.4%.The factors related to poor prognosis in single posterior communicating artery aneurysm include preoperative SAH times,Hunt-Hess grade,preoperative consciousness,different SAH grades on CT before operation,timing of operation and so on.Conclusion: The epidemiological characteristics of patients with posterior communicating artery aneurysms are not significantly different from the overall epidemiological characteristics of intracranial aneurysms,women are still in the majority,and the average age of women is higher than that of men.In terms of imaging features of aneurysms,posterior communicating artery aneurysms did not show a good side.Most of the posterior communicating artery aneurysms originated from the rear of the ICA-PCOA angle(567 cases,75.7%),but the patients who originated from the lateral wall of the PCOA segment were more likely to develop large or giant aneurysms than those from the ICA-PCOA angle(P < 0.001).The operation of large and giant posterior communicating artery aneurysms and mirror posterior communicating artery aneurysms has relatively special skills,especially the surgical methods of patients with mirrored posterior communicating artery aneurysms should be customized according to the general conditions of the patients and the imaging features of the aneurysms.