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首页> 外文期刊>Journal of neurosurgery. >Prediction of the difficulty of proximal vascular control using 3D-CTA for the surgical clipping of internal carotid artery?posterior communicating artery aneurysms
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Prediction of the difficulty of proximal vascular control using 3D-CTA for the surgical clipping of internal carotid artery?posterior communicating artery aneurysms

机译：用3D-CTA预测近型血管控制的近端血管控制的内部颈动脉的外科剪切？后沟通动脉瘤

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OBJECTIVE During surgical clipping of internal carotid artery (ICA)?posterior communicating artery (PCoA) aneurysms, proximal vascular control (PVC) is difficult to achieve in some cases because of variations in the anatomy of this type of aneurysm and its parent arteries. The authors investigated morphometric features that may be predictive for the necessity of anterior clinoidectomy (ACL) or cervical ICA exposure for PVC. METHODS The authors retrospectively reviewed 65 patients with an ICA-PCoA aneurysm treated with clipping during the previous 3 years. The factors considered for assessing the difficulty of attaining PVC included the following: the maximum diameter of the aneurysm; the distance between the tip of the anterior clinoid process (ACP) and the proximal aneurysmal neck; the presence of calcification at the ophthalmic segment of the ICA; and the angles between the communicating segment of the ICA and the ophthalmic segment of the ICA and a line perpendicular to the cranial base, which reflect the tortuosity of the ICA. These parameters were measured based on preoperative CTA results. RESULTS In a total of 21 patients (32.3%), PVC was difficult to perform with the usual pterional approach. In 6 patients, temporary artery occlusions (TAOs) were difficult to achieve because of severe atherosclerotic wall changes in the ophthalmic segment of the ICA. For 15 patients, the ACPs overhanging the ophthalmic segment of the ICA obstructed the ability to secure a space for TAO. In the 21 patients with PVC difficulty, ACL alone, cervical ICA exposure alone, and both ACL and cervical ICA exposure were conducted in 6, 8, and 7 patients, respectively. Multivariate analysis with binary logistic regression revealed that the maximum diameter of the aneurysm (p = 0.041), the distance between the proximal neck of the aneurysm and the ACP tip (p = 0.002), and calcification of the ICA ophthalmic segment (p = 0.001) were significant predictive factors for difficulties with PVC. A receiver operating characteristic curve analysis revealed that a distance between the proximal aneurysmal neck and the ACP tip of ? 5.4 mm was the best cutoff value for predicting the difficulty of attaining PVC (area under the curve 0.800, sensitivity 80.0%, specificity 80.0%). CONCLUSIONS A short distance between the proximal aneurysmal neck and the ACP tip and the presence of calcification at the ophthalmic segment of the ICA on preoperative CTA are helpful for predicting the difficulty of achieving
机译：目的：在颈内动脉（ICA）夹闭手术中？后交通动脉（PCoA）动脉瘤，近端血管控制（PVC）在某些情况下很难实现，因为这类动脉瘤及其载瘤动脉的解剖结构存在差异。作者研究了可能预测前路床突切除术（ACL）或颈部ICA暴露于PVC的必要性的形态计量学特征。方法回顾性分析过去3年65例颈内动脉PCoA动脉瘤夹闭治疗的患者。评估获得PVC难度的因素包括：动脉瘤的最大直径；前床突尖端与近端动脉瘤颈之间的距离；ICA眼段存在钙化；以及ICA的交通段和眼段之间的角度，以及一条垂直于颅底的线，这反映了ICA的弯曲度。这些参数是根据术前CTA结果测量的。结果共有21例患者（32.3%）难以采用常规翼点入路进行PVC手术。在6名患者中，由于ICA眼段严重的动脉粥样硬化壁改变，暂时性动脉闭塞（TAO）难以实现。在15名患者中，悬在ICA眼段的ACP阻碍了为TAO提供空间的能力。在21例PVC困难患者中，分别对6例、8例和7例患者进行了单独ACL、单独颈部ICA暴露，以及ACL和颈部ICA暴露。采用二元逻辑回归的多变量分析显示，动脉瘤的最大直径（p=0.041）、动脉瘤近端颈与ACP尖端之间的距离（p=0.002）和ICA眼段钙化（p=0.001）是PVC困难的重要预测因素。受试者操作特征曲线分析显示，近端动脉瘤颈和ACP尖端之间的距离？5.4mm是预测获得PVC难度的最佳截止值（曲线下面积0.800，敏感性80.0%，特异性80.0%）。结论术前CTA显示近端动脉瘤颈与ACP尖端之间的距离较短，且ICA眼段存在钙化，有助于预测手术难度

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