碩士 / 國立陽明大學 / 急重症醫學研究所 / 100 / Background: We retrospectively evaluated the adverse ischemic events as the early surgical results of microsurgical clipping of 44 and 34 posterior communicating artery (PComA) aneurysms through the pterional transsylvian and pretemporal transclinoidal approach, respectively, between January 2007 and October 2010.
Methods: The patients undergoing PComA aneurysm clipping were divided into two groups, and their immediate results were compared and analyzed. Those who underwent the pterional transsylvian approach, Group A, comprised 42 patients with 44 PComA aneurysms (24 ruptured and 20 unruptured). Those who underwent the pretemporal transclinoidal approach, Group B, comprised 32 patients with 34 PComA aneurysms (20 ruptured and 14 unruptured).
Results: The immediate postoperative total occlusion rates were 97.7% in Group A and 100% in Group B. The pretemporal transclinoidal approach significantly reduced the overall risk of silent and symptomatic ischemic strokes (p = 0.04) in ruptured PComA clippings and tended to lower the incidence of intraoperative aneurysm ruptures (p = 0.07) as well as the overall ischemic events (p = 0.06) in a total of 78 aneurysm clippings, as compared with the pterional transsylvian approach. Although not significantly, the pretemporal transclinoidal approach also tended to have lower incidence of intraoperative aneurysm ruptures in ruptured aneurysm clippings (p = 0.11) which were mainly responsible for the symptomatic ischemia. The pretemporal transclinoidal approach had no additional advantage over the traditional pterional transsylvian approach in unruptured PComA aneurysm clippings in the present study.
Conclusion: The pretemporal transclinoidal approach achieved better visualization of the vital neurovascular structures surrounding PComA aneurysms which might be a key improvement in lowering the risk of intraoperative aneurysm ruptures and obtaining significantly satisfactory immediate surgical results in the microsurgical clipping of PComA aneurysms, especially the ruptured ones.
| Identifer | oai:union.ndltd.org:TW/100YM005798005 |
| Date | January 2012 |
| Creators | Sanford PC. Hsu, 許秉權 |
| Contributors | Han-Shui Hsu, 許瀚水 |
| Source Sets | National Digital Library of Theses and Dissertations in Taiwan |
| Language | zh-TW |
| Detected Language | English |
| Type | 學位論文 ; thesis |
| Format | 65 |
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