Etienne Lefevre, Paul Brugerolles, Kévin Premat, Stéphanie Lenck, Eimad Shotar, Alice Jacquens, Vincent Degos, Anne Laure Boch, Alexandre Carpentier, Frédéric Clarencon, Aurélien Nouet
{"title":"腹前池填充独立预测异位动脉瘤破裂的不良神经预后。","authors":"Etienne Lefevre, Paul Brugerolles, Kévin Premat, Stéphanie Lenck, Eimad Shotar, Alice Jacquens, Vincent Degos, Anne Laure Boch, Alexandre Carpentier, Frédéric Clarencon, Aurélien Nouet","doi":"10.3174/ajnr.A8615","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and purpose: </strong>Ruptured PICA aneurysms present considerable treatment challenges due to their rarity and proximity to critical neurovascular structures. This study aims to report and critically analyze the long-term neurologic outcomes of patients with ruptured PICA aneurysms treated at our tertiary center and to evaluate the prognostic value of prepontine cistern filling grade on initial CT scans.</p><p><strong>Materials and methods: </strong>Clinical and radiologic data were retrospectively collected for consecutive patients with ruptured PICA aneurysms treated at our institution between January 2010 and December 2021. The prepontine cistern filling was graded from 0-3 on sagittal slices of the initial CT scan by 2 independent readers.</p><p><strong>Results: </strong>Fifty-seven patients with ruptured PICA aneurysms were included. The mean aneurysm diameter was 7.2 mm (SD ± 4.9), with a mean radiologic follow-up of 40.2 months (SD ± 45.2). Endovascular treatment was the primary technique (96.5%), with a small number (3.5%) requiring microsurgical clipping. Parent vessel sacrifice was performed in 49% of cases. Complete aneurysm occlusion was achieved in 79% of patients, with a recurrence rate of 19%. External ventricular drainage was necessary in 83% of patients, and 28% later required a permanent ventricular shunt. Symptomatic vasospasm occurred in 37% of patients. The in-hospital mortality rate was 11%, and 55% of survivors required a transient tracheostomy. At 1-year posthemorrhage, 60% had a good neurologic outcome. Multivariate analysis revealed that poor neurologic outcomes were significantly associated with higher grade of prepontine cistern filling (<i>P</i> < .05) and in those whose parent vessel had to be sacrificed (<i>P</i> < .05).</p><p><strong>Conclusions: </strong>Ruptured PICA aneurysms carry a grim prognosis and pose major management challenges. Both the grade of prepontine cistern filling on initial CT scan and the need for parent vessel sacrifice are important prognostic factors.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 5","pages":"929-935"},"PeriodicalIF":0.0000,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091981/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prepontine Cistern Filling Independently Predicts Poor Neurologic Outcomes in Ruptured PICA Aneurysms.\",\"authors\":\"Etienne Lefevre, Paul Brugerolles, Kévin Premat, Stéphanie Lenck, Eimad Shotar, Alice Jacquens, Vincent Degos, Anne Laure Boch, Alexandre Carpentier, Frédéric Clarencon, Aurélien Nouet\",\"doi\":\"10.3174/ajnr.A8615\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and purpose: </strong>Ruptured PICA aneurysms present considerable treatment challenges due to their rarity and proximity to critical neurovascular structures. This study aims to report and critically analyze the long-term neurologic outcomes of patients with ruptured PICA aneurysms treated at our tertiary center and to evaluate the prognostic value of prepontine cistern filling grade on initial CT scans.</p><p><strong>Materials and methods: </strong>Clinical and radiologic data were retrospectively collected for consecutive patients with ruptured PICA aneurysms treated at our institution between January 2010 and December 2021. The prepontine cistern filling was graded from 0-3 on sagittal slices of the initial CT scan by 2 independent readers.</p><p><strong>Results: </strong>Fifty-seven patients with ruptured PICA aneurysms were included. The mean aneurysm diameter was 7.2 mm (SD ± 4.9), with a mean radiologic follow-up of 40.2 months (SD ± 45.2). Endovascular treatment was the primary technique (96.5%), with a small number (3.5%) requiring microsurgical clipping. Parent vessel sacrifice was performed in 49% of cases. Complete aneurysm occlusion was achieved in 79% of patients, with a recurrence rate of 19%. External ventricular drainage was necessary in 83% of patients, and 28% later required a permanent ventricular shunt. Symptomatic vasospasm occurred in 37% of patients. The in-hospital mortality rate was 11%, and 55% of survivors required a transient tracheostomy. At 1-year posthemorrhage, 60% had a good neurologic outcome. Multivariate analysis revealed that poor neurologic outcomes were significantly associated with higher grade of prepontine cistern filling (<i>P</i> < .05) and in those whose parent vessel had to be sacrificed (<i>P</i> < .05).</p><p><strong>Conclusions: </strong>Ruptured PICA aneurysms carry a grim prognosis and pose major management challenges. Both the grade of prepontine cistern filling on initial CT scan and the need for parent vessel sacrifice are important prognostic factors.</p>\",\"PeriodicalId\":93863,\"journal\":{\"name\":\"AJNR. American journal of neuroradiology\",\"volume\":\"46 5\",\"pages\":\"929-935\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-05-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091981/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"AJNR. American journal of neuroradiology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3174/ajnr.A8615\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"AJNR. 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引用次数: 0
摘要
背景和目的：破裂的异食动脉瘤由于其罕见且靠近关键的神经血管结构，给治疗带来了相当大的挑战。本研究旨在报告和批判性分析在我们三级中心治疗的异位动脉瘤破裂患者的长期神经系统预后，并评估初始CT扫描时预池填充等级的预后价值。材料和方法：回顾性收集2010年1月至2021年12月在我院连续治疗的异位动脉瘤破裂患者的临床和放射学资料。2位独立的读取器对初始CT矢状面切片的预断层池充盈从0-3分进行分级。结果：纳入57例异位动脉瘤破裂患者。平均动脉瘤直径为7.2 mm (SD±4.9)，平均放射学随访40.2个月（SD±45.2）。血管内治疗是主要技术（96.5%），少数（3.5%）需要显微手术夹紧。49%的病例行母血管牺牲。79%的患者实现了动脉瘤完全闭塞，复发率为19%。83%的患者需要外心室引流，28%的患者需要永久性心室分流术。37%的患者出现症状性血管痉挛。住院死亡率为11%，55%的幸存者需要短暂的气管切开术。在出血1年后，60%的患者神经系统预后良好。多因素分析显示，较差的神经系统预后与较高的术前池充盈程度（P < 0.05）和必须牺牲母血管的患者（P < 0.05）显著相关。结论：异位动脉瘤破裂预后恶劣，对治疗提出了重大挑战。CT初扫时池池充盈程度和是否需要牺牲母血管是重要的预后因素。
Background and purpose: Ruptured PICA aneurysms present considerable treatment challenges due to their rarity and proximity to critical neurovascular structures. This study aims to report and critically analyze the long-term neurologic outcomes of patients with ruptured PICA aneurysms treated at our tertiary center and to evaluate the prognostic value of prepontine cistern filling grade on initial CT scans.
Materials and methods: Clinical and radiologic data were retrospectively collected for consecutive patients with ruptured PICA aneurysms treated at our institution between January 2010 and December 2021. The prepontine cistern filling was graded from 0-3 on sagittal slices of the initial CT scan by 2 independent readers.
Results: Fifty-seven patients with ruptured PICA aneurysms were included. The mean aneurysm diameter was 7.2 mm (SD ± 4.9), with a mean radiologic follow-up of 40.2 months (SD ± 45.2). Endovascular treatment was the primary technique (96.5%), with a small number (3.5%) requiring microsurgical clipping. Parent vessel sacrifice was performed in 49% of cases. Complete aneurysm occlusion was achieved in 79% of patients, with a recurrence rate of 19%. External ventricular drainage was necessary in 83% of patients, and 28% later required a permanent ventricular shunt. Symptomatic vasospasm occurred in 37% of patients. The in-hospital mortality rate was 11%, and 55% of survivors required a transient tracheostomy. At 1-year posthemorrhage, 60% had a good neurologic outcome. Multivariate analysis revealed that poor neurologic outcomes were significantly associated with higher grade of prepontine cistern filling (P < .05) and in those whose parent vessel had to be sacrificed (P < .05).
Conclusions: Ruptured PICA aneurysms carry a grim prognosis and pose major management challenges. Both the grade of prepontine cistern filling on initial CT scan and the need for parent vessel sacrifice are important prognostic factors.
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