伴动眼神经麻痹的未破裂后交通动脉动脉瘤的形态和血流动力学特点分析

Analysis of morphological and hemodynamic characteristics of unruptured posterior communicating artery aneurysms with oculomotor nerve paralysis

目的分析伴动眼神经麻痹的未破裂后交通动脉（PCoA）动脉瘤的形状及血流动力学特点。方法回顾性研究首都医科大学附属北京天坛医院神经介入科2014年1月至2015年6月收治的未破裂单发PCoA动脉瘤患者70例。按照其主要临床症状分为无症状组、动眼神经麻痹组、其他临床症状组。对患者个体化的三维DSA图像进行数值模拟分析，对比各组形状和血流动力学参数的区别。结果（1）动眼神经麻痹组的平均径颈比为1．75±0．46，高于无症状组的1．15±0．44及其他临床症状组的1．20±0．42，差异有统计学意义（P〈0．01）；而3组问动脉瘤的侧壁／分叉分型、是否带子瘤、最大径、瘤颈宽度、表面积及体积差异均无统计学意义（P〉0．05）。（2）动眼神经麻痹组的平均壁面切应力为0．48±0．21，低于无症状组的0．68±0．24和其他临床症状组的0．82±0．22，差异有统计学意义（P〈0．01）；动眼神经麻痹组的低壁面切应力面积百分比的中位数（四分位间距）为3．77％（1．48％，27．16％），高于无症状组的0．15％（0．00％，1．Cr7％）及其他临床症状组的0．03％（0．00％，0．44％），差异有统计学意义（P〈0．01）；3组之间壁面切应力震荡因子的对比差异无统计学意义（P=0．420）。结论伴动眼神经麻痹的未破裂PCoA动脉瘤，具有高径颈比及低壁面切应力，可能是未破裂PCoA动脉瘤中的高风险类型。

Objective To analyze the morphological and hemodynamic characteristics of unruptured posterior communicating artery aneurysms （PCoA） with oculomotor nerve paralysis. Methods Seventy patients with unruptured single PCoA aneurysm admitted to the Department of Neural Interventional Radiology, Beijing Tiantan Hospital, Capital Medical University from January 2014 to June 2015 were studied retrospectively. According to their main clinical symptoms, they were divided into 3 groups： asymptomatic group （including mild headache and dizziness）, oculomotor nerve palsy group, and other clinical symptom group. The numerical simulation analysis was conducted for the individualized three dimensional DSA images of patients. The differences of shape and hemodynamic parameters in each group were compared. Results （ 1 ） The mean diameter to neck ratio of the oculomotor nerve palsy group was 1.75±0.46. It was higher than 1.15±0.44 of the asymptomatic group and 1.20±0.42 of the other clinical symptom group. There were signifieant differences （P 〈0.01） , and there were no significant differences in the side wall/bifurcation type, having daughter blebs or not, maximum diameter, neek width, surface area and volume among the 3 groups （ P 〉 0.05 ）. （2） The mean wall shear stress （WSS） in the oculomotor nerve palsy group was 0.48±0.21. It was lower than 0.68±0. 24 of the asymptomatie group and 0.82±0. 22 of the other clinical symptom group. There was significant difference （P 〈0.01 ）. The median （ quartile range） low WSS area（LSA） percentage in the oculomotor nerve palsy group was 3.77% （ 1.48%, 27.16% ）. It was higher than 0. 15% （0. 00%, 1.07% ） of the asymptom group and 0.03% （0. 00%, 0. 44% ） of the other clinical symptom group. There were significant differences （P 〈0.01）. There were no significant differenees in oscillatory shear index （OSI） among the 3 groups （P = 0.420）. Conclusions Unruptured PCoA aneurysms with oculomotor nerve palsy have high dome to neck ratio and low WSS. It may be a high-risk type in unruptured PCoA aneurysms.