| Objective:To explore the risk factors related to posterior communicating aneurysm rupture,so as to evaluate the rupture risk of non-ruptured communicating aneurysm and to provide timely and effective intervention.To analyze the prognosis of patients with ruptured posterior communicating aneurysm after craniotomy clipping,in order to find out the risk factors leading to poor prognosis,so as to provide the corresponding theoretical basis for clinical work.Methods:Part ⅠClinical and morphological factors associated with posterior communicating aneurysm ruptureA total of 80 patients with typical posterior communicating aneurysm admitted to the neurosurgery department of our hospital from January 2017 to December 2018 were selected.According to whether the aneurysm ruptured or not,it was divided into ruptured group and non-ruptured group.The sample size,gender,age,history of hypertension,history of atherosclerosis,smoking history and family history of aneurysm of the ruptured group and the unruptured group were analyzed.Philips DICOM Viewer 3.0software was used to measure the DSA image data of the skull of patients in the ruptured group and the unruptured group to obtain the relevant morphological parameters of posterior communicating aneurysm and its parent vessel,and calculate other morphological parameters based on the measured data.Statistical software SPSS 17.0was used to analyze the data and draw the conclusion.Part Ⅱ Factors influencing the prognosis of craniotomy for posterior communicating aneurysmThe patients in the above rupture group(all of whom had undergone intracranial hematoma removal and craniotomy clipping in neurosurgery in our hospital)were followed up for 2 weeks after surgery.According to the postoperative Glasgow score,they were divided into the group with good prognosis and the group with poor prognosis,namely,the score ≥9 was divided into the group with good prognosis and the group with poor prognosis was divided into the group with less than 8.The amount of intracranial hematoma before operation and the clearance rate of intracranial hematoma after operation were calculated.Statistical good prognosis group with poor prognosis in patients with preoperative Hunt and Hess grade Ⅱ + Ⅲ cases(n),intracranial hematoma volume(ml)preoperatively,average intraoperative aneurysm regional operation time(min)(that is,starting from the traffic artery after exposure to an aneurysm clip to complete the time spent),the average postoperative hematoma clearance rate(%),postoperative bone disc decompression cases(n)and postoperative pulmonary infection cases(n);Statistical software SPSS 17.0 was used to analyze the data and draw the conclusion.Results:Part ⅠClinical and morphological factors associated with posterior communicating aneurysm rupture1.Basic information of the patients and statistical results of clinical data:In this study,a total of 80 patients with posterior communicating aneurysm were included,including 32 males(40.0%)and 48 females(60.0%),aged from 38 to 85 years old,with an average age of 60.95±11.22 years.There were 54 cases(67.5%)in the rupture group and 26 cases(32.5%)in the non-rupture group.The proportion of history of atherosclerosis in the ruptured group(72.2%)was significantly higher than that in the unruptured group(34.6%)(P=0.001).A history of atherosclerosis(OR=0.204,P=0.002,95%ci: 0.075,0.556)was an independent risk factor for posterior communicating aneurysm rupture(P < 0.05).2.Statistical results of morphological parameters of posterior communicating aneurysm:The diameter of C4 segment of the internal carotid artery in the ruptured group(i.e.,C4 diameter,the same below)(37.22±14.81)was significantly greater than that of the unruptured group(31.07±7.29)(P=0.031).The diameter of C5 in the fracture group(37.67±13.90)was significantly greater than that in the non-fracture group(29.31±8.47)(P=0.004).The diameter of C6 in the fracture group(30.04±10.72)was significantly greater than that in the non-fracture group(24.09±5.96)(P=0.006).The diameter of C7 in the fracture group(25.92±8.06)was significantly greater than that in the non-fracture group(21.79±5.05)(P=0.033).The C6/PCoA Angle(102.23°±13.14°)in the fracture group was significantly higher than that in the non-fracture group(92.22°±12.81°)(P=0.005).The neck diameter of the ruptured group(31.18±7.40)was significantly greater than that of the unruptured group(27.16±5.48)(P=0.018).The diameter of tumor neck /PCoA in the ruptured group(1.29±0.32)was significantly higher than that in the non-ruptured group(1.06±0.30)(P=0.008).The incidence Angle of posterior communicating aneurysm in the ruptured group(120.71°±18.18°)was significantly higher than that in the unruptured group(108.82°±16.98°)(P=0.014).The component ratio of spherical aneurysm in the ruptured group(38.9%)was significantly lower than that in the unruptured group(65.4%)(P=0.026).Increased C7 segment diameter(OR=0.707,P=0.008),increased C6/PCoA Angle(OR=0.911,P=0.022),increased neck diameter /PCoA diameter(OR=0.026,P=0.023),increased incidence Angle of posterior communicating aneurysm(OR=0.916,P=0.037),and decreased ratio of spherical aneurysm(OR=0.029,P=0.002)were all independent risk factors for posterior communicating aneurysm rupture(P < 0.05).Part Ⅱ Factors influencing the prognosis of craniotomy for posterior communicating aneurysmA total of 54 patients in the rupture group were included in this study,including 21males(38.9%)and 33 females(61.1%),aged from 38 to 85 years,with an average age of60.06±11.48 years.Good prognosis group a total of 41 cases(including preoperative Hunt and Hess class Ⅱ 19 cases,Ⅲ level 16 cases,Ⅳ level 6 cases,Ⅴ level 0),poor prognosis group of 13 cases(including preoperative Hunt and Hess class Ⅱ 4cases,Ⅲ level 3 cases,Ⅳ level in 2 cases,Ⅴ level 4 cases).Set good prognosis in patients with preoperative Hunt and Hess grade Ⅱ + Ⅲ cases constitute ratio(85.4%),significantly higher than in poor prognosis group(53.8%)(P =0.017);The proportion of postoperative pulmonary infection cases in the group with good prognosis(43.9%)was significantly lower than that in the group with poor prognosis(76.9%)(P=0.038).The preoperative mean hematoma volume(ml)of the patients with good prognosis(40.10±10.88)was significantly lower than that of the patients with poor prognosis(51.54±6.91)(P=0.001).The average hematoma clearance rate(%)in the patients with good prognosis(95.12±3.81)was significantly higher than that in the patients with poor prognosis(91.00±5.72)(P=0.004).Increased preoperative intracranial hematoma(OR=1.168,P=0.018,95%ci: 1.027,1.327)was an independent risk factor for poor prognosis in the posterior communicating aneurysm rupture group(P < 0.05).Conclusions:Part ⅠClinical and morphological factors associated with posterior communicating aneurysm ruptureA history of atherosclerosis(OR=0.204,P=0.002,95%ci: 0.075,0.556)was an independent risk factor for posterior communicating aneurysm rupture(P <0.05).Increased C7 segment diameter(OR=0.707,P=0.008),increased C6/PCoA Angle(OR=0.911,P=0.022),increased neck diameter /PCoA diameter(OR=0.026,P=0.023),increased incidence Angle of posterior communicating aneurysm(OR=0.916,P=0.037),and decreased ratio of spherical aneurysm(OR=0.029,P=0.002)were all independent risk factors for posterior communicating aneurysm rupture(P < 0.05).Part Ⅱ Factors influencing the prognosis of craniotomy for posterior communicating aneurysmIncreased preoperative intracranial hematoma(OR=1.168,P=0.018,95%ci: 1.027,1.327)was an independent risk factor for poor prognosis in the posterior communicating aneurysm rupture group(P < 0.05). |
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