治疗同时发生的垂体腺瘤和洞穴鼻动脉瘤的算法:系统性审查和病例报告
Matthew Holdaway1, Shayan Huda2, Randy S D'Amico3
1Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra New York, NY, United States; Albany Medical College, Albany, NY, United States.
概括
垂体腺瘤 (PA) 很少与脑动脉瘤共存. 这项研究提出了一种管理算法,优先考虑通过线圈栓塞或如果没有视觉症状存在的支架进行动脉瘤治疗. 对PA的手术干预以动脉瘤位置和视觉影响为指导.
科学领域:
- 神经外科 神经外科
- 内血管外科 血管内血管外科
- 神经瘤学神经瘤学
背景情况:
- 垂体腺瘤 (PA) 很少与细胞内或洞内动脉瘤同时发生.
- 对于管理这种双重病理,仅有有限的临床指导.
- 这项研究旨在开发一种治疗算法,用于同时发生的PA和脑动脉瘤.
研究的目的:
- 为管理与脑动脉瘤同时发生的垂体腺瘤提供临床决策算法.
- 根据患者表现和腺瘤和动脉瘤之间的空间关系指导治疗策略.
主要方法:
- 根据PRISMA指南进行了全面的文献搜索.
- 在数据库中,使用与垂体腺瘤和内动脉/洞穴鼻动脉瘤相关的术语进行了搜索.
- 这项分析包括了24项涉及24名患者的24项研究.
主要成果:
- 12名患者 (50%) 呈现出视觉症状.
- 十名患者 (42%) 的动脉瘤嵌入腺瘤,而14人 (58%) 的动脉瘤邻近.
- 嵌入式动脉瘤与破裂事件有显著的关联.
结论:
- 视力丧失是治疗决策的一个关键因素.
- 对于无症状患者,优先考虑动脉瘤治疗 (卷轴或支架).
- 对于有症状的患者,治疗取决于动脉瘤的位置:对相邻动脉瘤进行跨形切除,并对嵌入动脉瘤进行头骨切除,具有潜在的ICA封闭.
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