在未破裂的大脑动脉瘤的成功和无事件的手术干预后,对"亚临床后果"的可视化
Ryuzaburo Kanazawa1, Tomoyuki Yoshihara2, Takanori Uchida1
1Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Japan.
World neurosurgery
|October 21, 2024
概括
脑动脉瘤的手术剪切 (SC) 可能会导致持续的亚临床损伤,至少两年内脑血流 (CBF) 减少. 内血管卷积 (EC) 显示出较少明显的潜在可逆的亚临床后果.
科学领域:
- 神经外科 神经外科
- 放射学 放射学是一门学科.
- 神经学 神经学
背景情况:
- 未破裂的大脑动脉瘤需要通过手术剪切 (SC) 或内血管卷积 (EC) 进行治疗.
- 研究了术后认知功能,但亚临床损伤仍未得到充分研究.
- 检测亚临床后果对于理解长期结果至关重要.
研究的目的:
- 为了检测未破裂的大脑动脉瘤的SC和EC后的亚临床损伤.
- 为了比较SC和EC之间的亚临床后果的发生率和持续性.
- 评估大脑血流 (CBF) 变化作为亚临床损伤的指标.
主要方法:
- 用SC或EC治疗的前部循环动脉瘤患者被招募.
- 使用N-异烯-p-[123I]胺 (123I-IMP) -单光子发射计算机断层扫描 (SPECT) 来测量ipsilateral/contralateral CBF比率 (I/C比率). 在此过程中,我们测量了两侧 CBF比率 (I/C比率).
- 亚临床后果被定义为手术后的CBF减少,没有认知或其他放射性异常,在干预后6个月和2年评估.
主要成果:
- 在整个研究期间,在任何一组中都没有观察到显著的认知衰退.
- 与EC组相比,SC组在6个月和2年后的I/C比率明显较低 (P <0.01).
- 在EC组的I/C比率正常化了2年,而在SC组的I/C比率仍然下降.
结论:
- 123 I-IMP SPECT 检测出 ipsilateral CBF 在统计学上显著的减少,这表明了亚临床后果.
- 在SC后的亚临床损伤可以在没有事件的临床过程的患者中持续至少2年.
- 与外科切割 (SC) 相比,内血管卷积 (EC) 导致的亚临床后果较少.
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