Posterior Cerebral Artery Aneurysms: Treatment and Outcome Analysis in 121 Patients

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• 作者：Felix Goehre¹ ; ² ; ^{fgoehre@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Behnam Rezai Jahromi¹ ; Martin Lehecka¹ ; Hanna Lehto¹ ; Riku Kivisaari¹ ; Hugo Andrade-Barazarte¹ ; Tarik F. Ibrahim¹ ; Richard Gonzalo Pá ; rraga⁴ ; Christopher Ludtka² ; Hans Jö ; rg Meisel² ; Timo Koivisto³ ; Mikael von und zu Fraunberg³ ; Mika Niemelä ; ¹ ; Juha E. Jä ; ä ; skelä ; inen³ ; Juha A. Hernesniemi¹
• 关键词：Aneurysm ; Outcome ; Posterior Cerebral Artery ; Treatment
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：92
• 期：Complete
• 页码：521-532
• 全文大小：4781 K

文摘

Aneurysms of the posterior cerebral artery (PCA) are uncommon. Because of their low incidence, only 5 series with more than 30 patient cases have been reported. The treatment of PCA aneurysms is challenging because of the high frequency of fusiform aneurysms and closeness to important neuroanatomic structures.

Methods

A total of 121 patients with 135 PCA aneurysms were reviewed. The clinical and radiologic data, treatment strategies, and 1-year outcomes were analyzed. Patients with giant aneurysms, associated aneurysms, and aneurysms on arteriovenous malformation-feeding PCAs were considered as complex cases. Outcomes were categorized into 3 groups: good (modified Rankin Scale [mRS], score 0–1), moderate (mRS score, 2–4), and poor (mRS score, 5–6).

Results

There were 52 ruptured (39%) and 83 unruptured (61%) PCA aneurysms in 121 patients, with the following distribution: P1 (n = 53), P1/2 (n = 39), P2 (n = 28), and P3 (n = 15). The incidence of fusiform PCA aneurysms was high (24%). Microsurgical treatment was applied to 63 aneurysms and endovascular treatment to 19 aneurysms; 55 aneurysms were treated conservatively. The following treatment results were achieved: for patients with unruptured PCA aneurysms, n = 19; 12 good outcomes, 63%; 6 moderate, 31%; 1 poor, 1%; for patients with ruptured PCA aneurysms, n = 27; 10 good, 37%; 9 moderate, 33%; 8 poor, 30%; and for patients with complex neurovascular diseases and PCA aneurysms, n = 96; 42 good, 43%; 40 moderate, 42%; 14 poor, 15%.

Conclusions

Aneurysms of the PCA are infrequent and often associated with other vascular diseases. Microsurgery and endovascular treatment are effective for the occlusion of PCA aneurysms. The preservation or reconstruction of the parent vessel is crucial for favorable treatment outcomes.