Nomogram model for predicting oculomotor nerve palsy in patients with intracranial aneurysm

AIM:To explore the risk factors of oculomotor nerve palsy(ONP)in patients with intracranial aneurysm(IA)and develop a nomogram model for predicting ONP of IA patients.METHODS:A total of 329 IA patients were included.Logistic regression analysis was applied to identify independent factors,which were then integrated into the nomogram model.The performance of the nomogram model was evaluated by calibration cur ve,receiver operating curve(ROC),and decision curve analysis.RESULTS:Univariate and multivariate logistic regression analysis indicated posterior communicating artery(PCo A)aneur ysm[hazard ratio(HR)=17.13,P<0.001]and aneurysm diameter(HR=1.31,P<0.001)were independent risk factors of ONP in IA patients.Based on the results of logistic regression analysis,a nomogram model for predicting the ONP in IA patients was constructed.The calibration curve indicated the nomogram had a good agreement between the predictions and observations.The nomogram showed a high predictive accuracy and discriminative ability with an area under the curve(AUC)of 0.863.The decision curve analysis showed that the nomogram was powerful in the clinical decision.PCo A aneurysm(HR=3.38,P=0.015)was identified to be the only independent risk factor for ONP severity.CONCLUSION:PCo A aneurysm and aneurysm diameter are independent risk factors of ONP in IA patients.The nomogram established is performed reliably and accurately for predicting ONP.PCo A aneurysm is the only independent risk factor for ONP severity.

Morphological predictors of posterior communicating artery aneurysms rupture

Objective: The conflicting findings of previous morphological studies on intracranial aneurysm rupture may be caused by the different locations of aneurysms. We aimed to determine the independent risk factors of aneurysm rupture by focusing on only posterior communicating artery(Pcom A) aneurysms. Methods: In 89 PcomA aneurysms(58 ruptured, 31 unruptured), clinical and morphological characteristics were compared between the ruptured and unruptured groups. Multivariate logistic regression analysis was performed to determine the independent predictors for the rupture status of PcomA aneurysms. Results: In univariate analyses, the aneurysm dome size, aspect ratio, size ratio,dome‐to‐neck ratio, and inflow angle were significant parameters. With multivariate analyses, only the aneurysm dome size and inflow angle were significantly associated with the rupture status of PcomA aneurysms. Conclusions: Morphology was related with rupture of PcomA aneurysms. The aneurysm dome size and inflow angle were found to be the independent parameters characterizing the rupture status of PcomA aneurysms.

Intentional Compartmentalized Embolization of Wide-neck Aneurysms Incorporating the Posterior Communicating Artery to Preserve Flow

Background:Endovascular coiling for wide-neck aneurysms with a branch arising from the aneurysmal sac is challenging and sometimes considered impossible.This study aims to present our experience in treating wide-neck internal carotid artery(ICA)aneurysms with a posterior communicating artery(PComA)arising from the sac using a strategy of stenting the ICA and intentional compartmentalization to preserve the flow in the PComA.Methods:Eight consecutive cases of wide-neck ICA aneurysms with a fetal-type PComA arising from the aneurysmal sac were embolized from January 2015 to June 2018 at the First Affiliated Hospital,College of Medicine,Zhejiang University.Demographics,angiographic technique,procedural complications and clinical outcomes were reviewed.Results:There were 2 men and 6 women ranging from 56 to 81 years of age.Of the 8 cases,3 were ruptured and 5 were unruptured aneurysms.Stents were successfully deployed in all 8 cases.Near-complete occlusion was achieved in 3 cases(37.5%),neck remnant in 4(50%)and sac remnant in one(12.5%)of the cases.One case suffered transient ischemic attack after procedure completion.The clinical outcome was favorable in all 8 cases(modified Rankin scale 0-1).No rebleeding occurred during clinical follow-up.Conclusion:Stent-assisted compartmentalized embolization is feasible and safe in the treatment of wide-neck ICA aneurysm with a PComA arising from the sac.

后交通动脉瘤瘤体指向对夹闭术中和术后并发症的影响

目的评估后交通动脉瘤瘤体指向对于后交通动脉瘤夹闭术中、术后并发症的影响。方法回顾性分析2014年6月至2018年6月间在连云港市第一人民医院就诊的后交通动脉瘤破裂3d内行夹闭术且均在术后3d内行头颅CT平扫的患者共76例,动脉瘤根据瘤体的指向被分为向后方和侧方指向两组,动脉瘤的特征和术中情况均详细记录。研究分析两组不同指向动脉瘤间的特征和术中情况、术后CT检查结果的差异。结果向后和侧方指向的后交通动脉瘤两组间的Hunt-Hess分级、瘤颈比、初始脑内血肿的出现差异有统计学意义(P<0.05);术中破裂、跨血管夹的使用、动脉瘤与周围穿动脉粘连、术后梗塞、术后血肿的发生率两组间比较差异有统计学意义(P<0.05)。结论向后指向比向侧方指向的后交通动脉瘤发生夹闭术中和术后并发症的概率更高。

介入栓塞和手术夹闭治疗后交通动脉瘤围术期并发症对比研究

目的对比介入栓塞和手术夹闭治疗后交通动脉瘤围术期并发症情况。方法选自我院于2011-06-2016-06收治的后交通动脉瘤患者99例,按照随机数字表法分为手术组48例和介入组51例。手术组采用瘤颈夹闭术治疗,介入组采用介入栓塞治疗。比较2组围术期并发症发生情况、认知功能障碍发生情况及预后情况。结果 2组急性脑积水、动脉神经麻痹、肺部感染、脑梗死及颅内感染并发症发生率比较差异无统计学意义(P>0.05);2组认知功能障碍率和预后情况比较差异无统计学意义(P>0.05)。结论介入栓塞治疗和外科手术夹闭后交通动脉瘤均具有良好的效果,且预后良好,围术期并发症少。

血管内介入栓塞治疗后交通动脉瘤伴动眼神经麻痹对神经功能的影响

目的比较交通动脉瘤伴动眼神经麻痹在经血管内介入栓塞与开颅夹闭治疗中的临床效果。方法选取交通动脉瘤伴动眼神经麻痹患者72例,按照不同手术方式分为观察组及对照组,两组各36例。取血管内介入栓塞治疗的是观察组,择显微外科手术治疗的是对照组。对比两组手术相关指标、Glucose、NSE、IUPAC情况,以及术后动眼神经恢复、并发症发生率。结果手术后,观察组和对照组Glucose水平分别为(1.28±0.22)(1.73±0.40)mmol/l,IUPAC水平分别为(5.33±0.46)(6.77±1.22)mmol/l,NSE水平分别为(17.84±5.10)(26.13±8.92)μg/l,差异均有统计学意义(P<0.05);观察组患者手术时间、拔除导管时间和出血量均显著低于对照组,差异有统计学意义(P<0.05);观察组和对照组患者术后动眼神经恢复率分别为80.56%和63.89%,差异有统计学意义(P<0.05);两组患者出现主要并发症为脑水肿、脱水、脑梗死和血管痉挛,观察组和对照组并发症发生率分别为36.11%和55.56%,差异有统计学意义(P<0.05)。结论针对交通动脉瘤伴动眼神经麻痹患者,介入组在交通动脉瘤伴动眼神经麻痹患者治疗中比开颅夹闭更有优势,更具有临床应用价值。

探讨大脑后动脉动脉瘤出血患者术后神经系统并发症的危险因素及防治策略

目的 探讨大脑后动脉瘤出血患者术后神经系统并发症的危险因素及防治策略。方法 回顾性选择2019年2月至2021年2月在鹤壁市人民医院治疗的大脑后动脉动脉瘤出血患者325例为对象,根据患者术后是否发生神经系统并发症分为发生组(N=95例)和非发生组(N=230例)。查阅两组临床资料,包括:性别、年龄、心血管手术史、瘤体直径、白细胞计数等,并完成单因素和多因素Logistic回归分析;针对可能的危险因素采取相应的防治策略。结果 325例大脑后动脉动脉瘤出血患者神经系统并发症95例,发生率为29.23%。神经系统并发症排在前2位的分别为:脑血管痉挛和颅内感染,分别占46.32%和20.00%;单因素及多因素Logistic分析结果提示,术前合并症、心血管史、瘤体直径≥7 mm、术前脑神经系统症状、白细胞计数> 15(×10^(9)/L)及血肌酐≥115μmol/L等为术后神经系统并发症发生的独立危险因素,差异有统计学意义(P <0.05)。结论 大脑后动脉瘤出血患者术后神经系统并发症发生率较高,且危险因素相对较多,应根据危险因素采取相应的防治策略,降低术后神经系统并发症发生率。

对比介入栓塞和手术夹闭治疗后交通动脉瘤围手术期并发症情况

目的:探讨介入栓塞和手术夹闭治疗后交通动脉瘤围手术期并发症情况。方法:收治后交通动脉瘤患者108例,随机分为A组和B组,各54例。A组患者采用介入栓塞治疗,B组患者采用手术夹闭治疗。结果:两组患者并发症发生率、认知功能障碍情况差异无统计学意义(P>0.05)。结论:对后交通动脉瘤患者采用介入栓塞和手术夹闭治疗,均具有良好的临床治疗效果。

经Dolenc入路手术夹闭27例部分复杂性后交通动脉瘤的疗效分析

目的探讨经Dolenc入路手术夹闭部分复杂性后交通动脉瘤的疗效及其临床经验。方法回顾性收集徐州医科大学附属连云港医院神经外科及首都医科大学附属北京天坛医院神经外科自2014年7月至2019年6月经Dolenc入路手术夹闭的27例部分复杂性后交通动脉瘤患者的临床资料,分析其临床疗效并总结手术经验。结果术中26例动脉瘤夹闭顺利,1例改行包裹术。术前3例动眼神经麻痹患者中术后2例好转、1例无变化;术后新发4例动眼神经麻痹,经保守治疗后2例恢复正常、1例好转、1例无变化;术后2例发生基底节局灶性脑梗死,1例因脑积水行脑室腹腔分流。26例患者术后2周内DSA或CT血管成像复查均提示动脉瘤完全夹毕、无残留。术后9~12个月内随访示格拉斯哥预后评分5分20例、4分3例、3分2例、2分1例、死亡1例,影像学复查均未见动脉瘤复发。结论经Dolenc入路可通过硬膜外磨除前床突而获得良好的操作空间,充分暴露近端载瘤动脉,从而安全有效地手术夹闭部分复杂性后交通动脉瘤。

开颅夹闭术和弹簧圈栓塞术在破裂后交通动脉瘤的疗效比较

目的 分析对比显微夹闭术和栓塞术治疗后交通动脉瘤的疗效。方法 选择我院2014年1月-2019年1月收治的破裂后交通动脉瘤患者158例,根据治疗方法不同分成对照组(n=80)和观察组(n=78),对照组患者接受血管内栓塞术治疗,观察组患者接受开颅动脉瘤夹闭术治疗。比较两组患者功能障碍、临床疗效、并发症。结果 治疗后,两组患者功能障碍(改良Rankin)评分较治疗前降低,其中观察组患者功能障碍(改良Rankin)评分低于对照组(P<0.05)。观察组患者有效率高于对照组(P<0.05)。对照组患者并发症率低于观察组(P>0.05),无统计学意义。结论 显微夹闭术治疗后交通动脉瘤能显著提升临床疗效,改善患者功能,减少并发症,建议使用。