Symptomatic and silent cerebral infarction following surgical clipping of unruptured intracranial aneurysms: incidence, risk factors, and clinical outcome
机构:[1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing 100050, People’s Republic of China重点科室诊疗科室神经外科神经外科首都医科大学附属天坛医院[2]China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China[3]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China[4]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People’s Republic of China
Cerebral infarction (CI) associated with clipping of unruptured intracranial aneurysms (UIAs) has not been completely studied. The role of individual and operative characteristics is not known, and the risk of silent CI has not been well described. To determine the incidence, risk factors, and clinical outcome of postoperative CI, we retrospectively analyzed 388 consecutive patients undergoing clipping of UIAs between January 2012 and December 2015. We reviewed the pre- and postoperative computed tomography (CT) images of each patient. Postoperative CI was defined as a new parenchymal hypodensity in the vascular territory of treated artery. Patient-specific, aneurysm-specific, and operative variables were analyzed as potential risk factors. Functional outcome at discharge was assessed with the modified Rankin Scale (mRS). Postoperative CI was found in 49 (12.6%) patients, 29 of whom manifested neurological deficits. The incidences of symptomatic stroke and silent CI were 7.5 and 5.2%, respectively. Multivariate analysis showed that larger aneurysm size and history of hypertension were significantly associated with CI. Disability (mRS > 2) rate was 42.9% among patients with CI, which was substantially higher than that among patients without (0.9%). In conclusion, the incidence of CI following clipping of UIAs was not low. Larger aneurysm size and history of hypertension were independent risk factors. Postoperative symptomatic stroke correlated with an extremely high risk of disability. Silent CI was seemingly nondisabling, but the possible cognitive consequence is pending.
基金:
National Natural Science Foundation of ChinaNational Natural Science Foundation of China [81471210]; Beijing Municipal Commission of Science and Technology [D161100003816004]
第一作者机构:[1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing 100050, People’s Republic of China[2]China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China[3]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China[4]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People’s Republic of China
通讯作者:
通讯机构:[1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing 100050, People’s Republic of China[2]China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China[3]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China[4]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People’s Republic of China
推荐引用方式(GB/T 7714):
Maogui Li,Jun Wu,Xin Chen,et al.Symptomatic and silent cerebral infarction following surgical clipping of unruptured intracranial aneurysms: incidence, risk factors, and clinical outcome[J].NEUROSURGICAL REVIEW.2018,41(2):675-682.doi:10.1007/s10143-017-0913-1.
APA:
Maogui Li,Jun Wu,Xin Chen,Pengjun Jiang,Fan Yang...&Shuo Wang.(2018).Symptomatic and silent cerebral infarction following surgical clipping of unruptured intracranial aneurysms: incidence, risk factors, and clinical outcome.NEUROSURGICAL REVIEW,41,(2)
MLA:
Maogui Li,et al."Symptomatic and silent cerebral infarction following surgical clipping of unruptured intracranial aneurysms: incidence, risk factors, and clinical outcome".NEUROSURGICAL REVIEW 41..2(2018):675-682