超选择球囊闭塞试验在颅内复杂动脉瘤中的应用

Objective: To explore the clinical application of superselective balloon occlusion test (BOT) in complicated intracranial aneurysms and the safety and feasibility of imaging-based evaluation. Methods: A retrospective study was conducted on the clinical data of 16 patients who underwent superselective BOT for evaluation of intracranial complex aneurysms at Department of Neurosurgery, the First Medical Center of PLA General Hospital (n=15) and Department of Neurointervention, Beijing Anzhen Hospital, Capital Medical University (n=1). Among them, 12 patients had MCA (middle cerebral artery) complex aneurysms, 3 patients had PCA (posterior cerebral artery) aneurysms, and 1 patient had ACA (anterior cerebral artery) aneurysms. The patient's neurological function was assessed and the delay time of cortical capillary phase was calculated post temporary occlusion of the parent artery based on imaging results. The presence of neural dysfunction was considered as a positive test result. The collaterals were categorized based on the collateral flow grade of American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) by angiography. Surgical plans were chosen based on the test results. The outcomes were evaluated according to the modified Rankin Scale score (mRs). Results: Among 16 cases, there were no technical complications related to superselective BOT. In this series, 3 cases showed positive results of BOT and the remaining 13 had negative results. After temporary blocking of the parent artery, the delay time of cortical artery indication on imaging in the blood supply area was 0.5-2.5(1.4±0.7)s. In the trial, collateral blood flow was graded as poor in 4 cases (grade 1 or 2, including 2 patients with positive test results), and good in 12 cases (grade 3 or 4). Three test-positive patients underwent aneurysm isolation plus STA-MCA bypass surgery and 1 developed muscle weakness in the left upper limb after surgery. Thirteen test-negative patients underwent endovascular embolization of aneurysm or its parent artery ligation, and 3 patients showed mild neurological dysfunction after surgery. The follow-up duration was 3.0-6.0 (4.6±1.2) months in 16 patients, and the last follow-up of 16 patients revealed a mRS score of 0. Conclusions: The superselected BOT seems to be an effective way to predict the tolerance of parent artery occlusion. The preliminary experience indicates that it is safe and reliable, which could provide valuable information for clinical treatment options. More cases need to be collected to confirm the objective evaluation index.