脉络膜前动脉动脉瘤夹闭术后缺血并发症的相关研究进展
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摘要
脉络膜前动脉动脉瘤临床上较少见,发生率占颅内动脉瘤的2%~5%,破裂率为26.7%。由于脉络膜前动脉管径相对狭小、解剖结构复杂、手术夹闭治疗难度大、风险高,且术后并发症较常见。其中,最常见的并发症为脉络膜前动脉狭窄或闭塞造成的脉络膜前动脉综合征,严重影响患者神经功能的恢复。本文拟通过文献回顾,对脉络膜前动脉动脉瘤夹闭术后缺血并发症的诱因及预防保护措施进行综述。
Anterior choroidal artery aneurysms(ACh AAs)are rare in clinic,accounting for 2% to 5% of all intracranial aneurysms,and the rupture rate is 26.7%. Because of the complex anatomical structure and the relatively smaller diameter of the anterior choroidal artery(Ach A),the surgical operation is difficult and high-risked. Often the postoperative complications are present,among which,the most common one is the ACh A syndrome caused by the stenosis or obstruction of the ACh A. The syndrome can severely affect the post-operative recovery of patients' neurological functions. Through reviewing the previous literature,this study aimed at making a clue for the inducing factors of clip-induced ischemic complications of ACh AAs and their prevention approaches.
Anterior choroidal artery aneurysms(ACh AAs)are rare in clinic,accounting for 2% to 5% of all intracranial aneurysms,and the rupture rate is 26.7%. Because of the complex anatomical structure and the relatively smaller diameter of the anterior choroidal artery(Ach A),the surgical operation is difficult and high-risked. Often the postoperative complications are present,among which,the most common one is the ACh A syndrome caused by the stenosis or obstruction of the ACh A. The syndrome can severely affect the post-operative recovery of patients' neurological functions. Through reviewing the previous literature,this study aimed at making a clue for the inducing factors of clip-induced ischemic complications of ACh AAs and their prevention approaches.
引文
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[3]Yasargil MG,Yonas H,Gasser JC.Anterior choroidal artery aneurysms:their anatomy and surgical significance[J].Surg Neurol,1978,9(2):129-138.
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[6]Cho MS,Kim MS,Chang CH,et al.Analysis of clip-induced ischemic complication of anterior choroidal artery aneurysms[J].J Korean Neurosurg Soc,2008,43(3):131-134.
[7]Li J,Mukherjee R,Lan Z,et al.Microneurosurgical management of anterior choroidal artery aneurysms:a 16-year institutional experience of 102 patients[J].Neurol Res,2012,34(3):272-280.
[8]Kim BM,Kim DI,Chung EC,et al.Endovascular coil embolization for anterior choroidal artery aneurysms[J].Neuroradiology,2008,50(3):251-257.
[9]AndréA,Boch AL,Maria FD,et al.Complication risk factors in anterior choroidal artery aneurysm treatment[J].Clin Neuroradiol,2017[Epub ahead of print].
[10]Furtado SV,Venkatesh PK,Hegde AS.Neurological complications and surgical outcome in patients with anterior choroidal segment aneurysms[J].Int J Neurosci,2010,120(4):291-297.
[11]Bohnstedt BN,Kemp WJ 3rd,Li Y,et al.Surgical treatment of 127anterior choroidal artery aneurysms:a cohort study of resultant ischemic complications[J].Neurosurgery,2013,73(6):933-940.
[12]Friedman JA,Pichelmann MA,Piepgras DG,et al.Ischemic complications of surgery for anterior choroidal artery aneurysms[J].J Neurosurgery,2001,94(4):565-572.
[13]Vergouwen MD,Vermeulen M,van Gijn J,et al.Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies:proposal of a multidisciplinary research group[J].Stroke,2010,41(10):2391-2395.
[14]Vergouwen MD,Ilodigwe D,Macdonald RL.Cerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and-independent effects[J].Stroke,2011,42(4):924-929.
[15]Lee YS,Park J.Anterior choroidal artery aneurysm surgery:ischemic complications and clinical outcomes revisited[J].J Korean Neurosurg Soc,2013,54(2):86-92.
[16]Shibata Y,Fujita S,Kawaguchi T,et al.Use of microvascular Doppler sonography in aneurysm surgery on the anterior choroidal artery[J].Neurol Med Chir(Tokyo),2000,40(1):30-35.
[17]Suzuki K,Kodama N,Sasaki T,et al.Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery[J].J Neurosurg,2003,98(3):507-514.
[18]Grasso G,Landi A,Alafaci C.Multimodal intraoperative neuromonitoring in aneurysm surgery[J].World neurosurg,2017(101):763-765.
[19]Staarmann B,O’Neal K,Magner M,et al.Sensitivity and specificity of intraoperative neuromonitoring for identifying safety and duration of temporary aneurysm clipping based on vascular territory,a multimodal strategy[J].World Neurosurg,2017(100):522-530.
[2]Drake CG,Vanderlinden RG,Amacher AL.Carotid-choroidal aneurysms[J].J Neurosurg,1968,29(1):32-36.
[3]Yasargil MG,Yonas H,Gasser JC.Anterior choroidal artery aneurysms:their anatomy and surgical significance[J].Surg Neurol,1978,9(2):129-138.
[4]Senturk C,Bandeira A,Bruneau M,et al.Endovascular treatment of anterior choroidal artery aneurysms[J].J Neuroradiol,2009,36(4):228-232.
[5]Furtado SV,Venkatesh PK,Hegde AS.Neurological complications and surgical outcome in patients with anterior choroidal segment aneurysms[J].Int J Neurosci,2010,120(4):291-297.
[6]Cho MS,Kim MS,Chang CH,et al.Analysis of clip-induced ischemic complication of anterior choroidal artery aneurysms[J].J Korean Neurosurg Soc,2008,43(3):131-134.
[7]Li J,Mukherjee R,Lan Z,et al.Microneurosurgical management of anterior choroidal artery aneurysms:a 16-year institutional experience of 102 patients[J].Neurol Res,2012,34(3):272-280.
[8]Kim BM,Kim DI,Chung EC,et al.Endovascular coil embolization for anterior choroidal artery aneurysms[J].Neuroradiology,2008,50(3):251-257.
[9]AndréA,Boch AL,Maria FD,et al.Complication risk factors in anterior choroidal artery aneurysm treatment[J].Clin Neuroradiol,2017[Epub ahead of print].
[10]Furtado SV,Venkatesh PK,Hegde AS.Neurological complications and surgical outcome in patients with anterior choroidal segment aneurysms[J].Int J Neurosci,2010,120(4):291-297.
[11]Bohnstedt BN,Kemp WJ 3rd,Li Y,et al.Surgical treatment of 127anterior choroidal artery aneurysms:a cohort study of resultant ischemic complications[J].Neurosurgery,2013,73(6):933-940.
[12]Friedman JA,Pichelmann MA,Piepgras DG,et al.Ischemic complications of surgery for anterior choroidal artery aneurysms[J].J Neurosurgery,2001,94(4):565-572.
[13]Vergouwen MD,Vermeulen M,van Gijn J,et al.Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies:proposal of a multidisciplinary research group[J].Stroke,2010,41(10):2391-2395.
[14]Vergouwen MD,Ilodigwe D,Macdonald RL.Cerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and-independent effects[J].Stroke,2011,42(4):924-929.
[15]Lee YS,Park J.Anterior choroidal artery aneurysm surgery:ischemic complications and clinical outcomes revisited[J].J Korean Neurosurg Soc,2013,54(2):86-92.
[16]Shibata Y,Fujita S,Kawaguchi T,et al.Use of microvascular Doppler sonography in aneurysm surgery on the anterior choroidal artery[J].Neurol Med Chir(Tokyo),2000,40(1):30-35.
[17]Suzuki K,Kodama N,Sasaki T,et al.Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery[J].J Neurosurg,2003,98(3):507-514.
[18]Grasso G,Landi A,Alafaci C.Multimodal intraoperative neuromonitoring in aneurysm surgery[J].World neurosurg,2017(101):763-765.
[19]Staarmann B,O’Neal K,Magner M,et al.Sensitivity and specificity of intraoperative neuromonitoring for identifying safety and duration of temporary aneurysm clipping based on vascular territory,a multimodal strategy[J].World Neurosurg,2017(100):522-530.