Operative strategy of complex internal carotid artery- posterior communicating artery aneurysms Defensive effect on perioperative nerve injury

BACKGROUND: The two problems in treating intracranial aneurysm are the vascular reconstruction and brain protection, especially for complex internal carotid artery-posterior communicating artery (ICA-PComA) aneurysms.OBJECTIVE: To analyze the anatomic features and operative technique of complex ICA-PComA aneurysms, and investigate how to better protect the brain tissue.DESIGN: A retrospective case analysis. SETTING: Department of Neurosurgery, Dalian Central Hospital. PARTICIPANTS: Totally 154 inpatients with ICA-PComA aneurysms were selected from the Department of Neurosurgery, Dalian Central Hospital from January 1998 to December 2006, including 19 cases (12.3%) of complex ICA-PComA aneurysms, 8 males and 11 females, 38–67 years of age. Informed contents for surgery and observation were obtained from all the patients or their relatives.METHODS: The clinical manifestations, including initial symptoms and Hunt&Hess grading, were observed. Corresponding strategies were selected for different types of ICA-PComA aneurysms. The patients were followed up at 3 months postoperatively. According to the results of Glasgow scoring, the curative effects were classified as good (4–5 points), bad (2–3 points) and dead (1 point). The results at discharge were taken as early results, whereas the follow-up results as late results.MAIN OUTCOME MEASURES: Clinical manifestations and curative effects of the patients. RESULTS: All the 19 patients with ICA-PComA were involved in the analysis of results. For clinical manifestations, the initial symptoms were subarachnoid hemorrhage (n =15), paralysis of oculomotor nerve (n =3), and occasional attack (n =1); The Hunt&Hess grading was grade Ⅰ in 4 cases, grade Ⅱ in 6 cases, grade Ⅲ in 6 cases, grade Ⅳ in 2 cases, and grade Ⅴ in 1 case. The curative effects were that aneurysm breakage and bleeding occurred in 6 cases perioperatively, uncomplete clipping of aneurysm in 2 cases and constriction of parent artery in 1 case. The complications were nervous and ischemic ones. The early outcome was good in 12 cases and bad in 7 cases, no one died. The late outcome was good in 17 cases and bad in 2 cases.CONCLUSION: Complex ICA-PComA aneurysm is a particular aneurysm, thus different operative strategies should be adopted according to the conditions to improve the operative outcome and reduce ischemic and nervous injuries.

Operative strategy of complex internal carotid artery- posterior communicating artery aneurysms Defensive effect on perioperative nerve injury

BackgroundThe two problems in treating intracranial aneurysm are the vascular reconstruction and brain protection, especially for complex internal carotid artery-posterior communicating artery (ICA-PComA) aneurysms.ObjectiveTo analyze the anatomic features and operative technique of complex ICA-PComA aneurysms, and investigate how to better protect the brain tissue.DesignA retrospective case analysis.SettingDepartment of Neurosurgery, Dalian Central Hospital.ParticipantsTotally 154 inpatients with ICA-PComA aneurysms were selected from the Department of Neurosurgery, Dalian Central Hospital from January 1998 to December 2006, including 19 cases (12.3%) of complex ICA-PComA aneurysms, 8 males and 11 females, 38-67 years of age. Informed contents for surgery and observation were obtained from all the patients or their relatives.MethodsThe clinical manifestations, including initial symptoms and Hunt&;Hess grading, were observed. Corresponding strategies were selected for different types of ICA-PComA aneurysms. The patients were followed up at 3 months postoperatively. According to the results of Glasgow scoring, the curative effects were classified as good (4-5 points), bad (2-3 points) and dead (1 point). The results at discharge were taken as early results, whereas the follow-up results as late results.Main outcome measuresClinical manifestations and curative effects of the patients.ResultsAll the 19 patients with ICA-PComA were involved in the analysis of results. For clinical manifestations, the initial symptoms were subarachnoid hemorrhage (n =15), paralysis of oculomotor nerve (n =3), and occasional attack (n =1); The Hunt&;Hess grading was grade ? in 4 cases, grade ? in 6 cases, grade ? in 6 cases, grade ? in 2 cases, and grade ? in 1 case. The curative effects were that aneurysm breakage and bleeding occurred in 6 cases perioperatively, uncomplete clipping of aneurysm in 2 cases and constriction of parent artery in 1 case. The complications were nervous and ischemic ones. The early outcome was good in 12 cases and bad in 7 cases, no one died. The late outcome was good in 17 cases and bad in 2 cases.ConclusionComplex ICA-PComA aneurysm is a particular aneurysm, thus different operative strategies should be adopted according to the conditions to improve the operative outcome and reduce ischemic and nervous injuries.