Perianevrizmal ödemi olan intrakranial anevrizmaların endovaskülertedavi ve takip sonuçları
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Tarih
2023
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Amaç: Beyin MR incelemesinde çevresinde vazojenik ödemi bulunan intrakranial anevrizmaları olan hastaların endovasküler tedavi ve takip sonuçlarını sunmayı amaçladık. Gereç ve Yöntem: Ocak 2010 ve Mart 2022 tarihleri arasında Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Radyoloji Anabilim Dalı Girişimsel Radyoloji Ünitesi'nde tedavi edilen 29 hasta çalışmaya dahil edilmiştir. Hastaların işlem öncesi klinik durumları Modifiye Rankin Skalası ile değerlendirilmiştir. Tedavi sonrası 1. ay, 6. ay, ilk yıl ve sonraki yıllarında kontrole çağrılmışlardır. Kontroller anevrizma doluşunu değerlendirmek için MR Anjiografi ve DSA ile yapılırken, ödem takibi Kontrastsız Beyin MR ile yapılmıştır. Bulgular: Çalışmaya 15'i(%51.7) erkek, 14'ü(%49.3) kadın, yaşları 31 ile 83 arasında değişen(ortalama 58.4) 29 hasta dahil edilmiştir. Anevrizma boyutları 5 mm ile 80 mm(parsiyel tromboze) arasında (ortama çap 26.03 mm) değişmekteydi. Dahil edilen hastaların 11'inde parsiyel tromboze anevrizma mevcuttu. 5 hastada tanı anında subaraknoid kanama saptandı. Anevrizmaların yerleşim yerleri; 10 MCA bifurkasyon(%35), 5 baziller arter(%16), 4 İKA(%14), 2 oftalmik arter(%7), 1 koroidal arter(% 3.5), 1 vertebral arter(% 3.5), 1 ACA-A1 birleşim yeri(% 3.5), 1 ACom(% 3.5), 1 SSA(% 3.5), 1 PICA(% 3.5), 1 PCA-P2 birleşim yeri(% 3.5), 1 MCA M2-M3 bileşkesi(% 3.5) olarak belirlendi. 2 hastada anevrizma ile birlikte intrakranial AVM saptandı. İşlem sonrası takip süresi ortalama 21 ay, süre aralığı 1-45 ay arasındaydı. Hastaların uzun dönem takiplerinde 21 hastada Modifiye Raymond-Roy sınıflamasına göre Tip 1(%100 oklüzyon) görülürken, 4 hastada Tip 2(boyunda rezidü) oklüzyon görülmüştür. Tekrar doluş gösteren 1 anevrizma WEB, 1 anevrizma akım çevirici cihaz ile tedavi edilirken, 2 hasta tedaviye gelmemiştir. 19 hastada ödem bulguları başlangıç MR'a göre azalırken, 5 hastada stabil kaldığı ve 1 hastada geçirilen infarkta bağlı arttığı görülmüştür. Uzun dönem takiplerinde 19 hasta asemptomatik olarak yaşamına devam ederken, 10 hasta ex olmuştur. Sonuç: Perianevrizmal ödem intrakranial anevrizmaların nadir karşılaşılan bir komplikasyonu olmakla birlikte çoğu zaman hastalar bizim çalışmamızda da olduğu gibi asemptomatik olabilir veya nonspesifik baş ağrısı ile başvurabilirler. Çalışmamızın sonucunda literatürle uyumlu olarak büyük ve dev boyutlu anevrizmaların, parsiyel tromboze anevrizmaların ödem açısından riskli grupta yer aldığını düşünmekteyiz. Endovasküler tedavi hem rüptür riskini ortadan kaldırmakta hem de çalışmamızda göstermiş olduğumuz gibi perianevrizmal ödemi azaltmaktadır. Anahtar Kelimeler: İntrakranial anevrizma, perianevrizmal ödem, endovasküler tedavi, MR görüntüleme
Purpose: We aimed to present the endovascular treatment and follow-up results of patients with intracranial aneurysms and vasogenic edema around the aneurysm in brain MRI examination. Materials and Method: Between January 2010 and March 2022, 29 patients who were treated at Necmettin Erbakan University Meram Medical Faculty, Department of Radiology, Interventional Radiology Unit were included in the study. The clinical status of the patients before the procedure was evaluated with the Modified Rankin Scale. After the treatment, they were called for control in the 1st month, 6th month, first year and later years. Controls were performed with MR Angiography and DSA to evaluate aneurysm filling, while edema was monitored with Uncontrast Brain MRI. Results: A total of 29 patients, 15 (51.7%) male, 14 (49.3%) female, aged between 31 and 83 (mean 58.4) were included in the study. Aneurysm sizes ranged from 5 mm to 80 mm (partial thrombosed) (median diameter 26.03 mm). Eleven of the included patients had partial thrombosed aneurysms. SAH was detected in 5 patients at the time of diagnosis. Locations of aneurysms; 10 MCA bifurcation(%35), 5 basilar artery(%16), 4 ICA(%14), 2 ophthalmic artery(%7), 1 choroidal artery(%3.5), 1 vertebral artery(%3.5), 1 ACA-A1 junction(%3.5), 1 ACom(%3.5), 1 SSA(%3.5), 1 PICA(%3.5), 1 PCA-P2 junction(%3.5), 1 MCA M2-M3 junction(%3.5) was determined as. In addition to aneurysm, intracranial AVM was detected in 2 patients. The mean follow-up period after the procedure was 21 months, and the interval was between 1-45 months. In the long-term follow-up of the patients, Type 1 (100% occlusion) was observed according to the Modified Raymond-Roy classification in 21 patients, while Type 2 (residual neck) occlusion was observed in 4 patients. While 1 refilling aneurysm was treated with WEB and 1 aneurysm current converter, 2 patients did not come for treatment. Edema findings decreased in 19 patients compared to yhe initial MRI, remained stable in 5 patients and increased due to infarction in 1 patient. In the long term follow up, 19 patients survived as asymptomatic, while 10 patients died. Conclusion: Although perianeurysmal edema is a rare complication of intracranial aneurysms, most of the time, patients may be asymptomatic or present with nonspecific headache, as in our study. As a result of our study, we think that large and giant aneurysms and partially thrombosed aneurysms are in the risky group in terms of edema, consistent with the literature. Endovascular treatment both eliminates the risk of ruptures and reduces perianeurysmal edema, as we have shown in our study. Key Words: Intracranial aneurysm, perianeurysmal edema, endovascular treatment, MR Imaging
Purpose: We aimed to present the endovascular treatment and follow-up results of patients with intracranial aneurysms and vasogenic edema around the aneurysm in brain MRI examination. Materials and Method: Between January 2010 and March 2022, 29 patients who were treated at Necmettin Erbakan University Meram Medical Faculty, Department of Radiology, Interventional Radiology Unit were included in the study. The clinical status of the patients before the procedure was evaluated with the Modified Rankin Scale. After the treatment, they were called for control in the 1st month, 6th month, first year and later years. Controls were performed with MR Angiography and DSA to evaluate aneurysm filling, while edema was monitored with Uncontrast Brain MRI. Results: A total of 29 patients, 15 (51.7%) male, 14 (49.3%) female, aged between 31 and 83 (mean 58.4) were included in the study. Aneurysm sizes ranged from 5 mm to 80 mm (partial thrombosed) (median diameter 26.03 mm). Eleven of the included patients had partial thrombosed aneurysms. SAH was detected in 5 patients at the time of diagnosis. Locations of aneurysms; 10 MCA bifurcation(%35), 5 basilar artery(%16), 4 ICA(%14), 2 ophthalmic artery(%7), 1 choroidal artery(%3.5), 1 vertebral artery(%3.5), 1 ACA-A1 junction(%3.5), 1 ACom(%3.5), 1 SSA(%3.5), 1 PICA(%3.5), 1 PCA-P2 junction(%3.5), 1 MCA M2-M3 junction(%3.5) was determined as. In addition to aneurysm, intracranial AVM was detected in 2 patients. The mean follow-up period after the procedure was 21 months, and the interval was between 1-45 months. In the long-term follow-up of the patients, Type 1 (100% occlusion) was observed according to the Modified Raymond-Roy classification in 21 patients, while Type 2 (residual neck) occlusion was observed in 4 patients. While 1 refilling aneurysm was treated with WEB and 1 aneurysm current converter, 2 patients did not come for treatment. Edema findings decreased in 19 patients compared to yhe initial MRI, remained stable in 5 patients and increased due to infarction in 1 patient. In the long term follow up, 19 patients survived as asymptomatic, while 10 patients died. Conclusion: Although perianeurysmal edema is a rare complication of intracranial aneurysms, most of the time, patients may be asymptomatic or present with nonspecific headache, as in our study. As a result of our study, we think that large and giant aneurysms and partially thrombosed aneurysms are in the risky group in terms of edema, consistent with the literature. Endovascular treatment both eliminates the risk of ruptures and reduces perianeurysmal edema, as we have shown in our study. Key Words: Intracranial aneurysm, perianeurysmal edema, endovascular treatment, MR Imaging
Açıklama
Anahtar Kelimeler
İntrakranial anevrizma, perianevrizmal ödem, Endovasküler tedavi, MR görüntüleme, Intracranial aneurysm, Perianeurysmal edema, Endovascular treatment, MR Imaging
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Künye
Ak. B. (2023). Perianevrizmal ödemi olan intrakranial anevrizmaların endovaskülertedavi ve takip sonuçları. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Radyoloji Anabilim Dalı, Konya.
