巨大症状性颈内动脉海绵窦段动脉瘤的手术治疗  

The surgery of giant symptomatic cavernous sinus aneurysms

作　　者：王芙昱[1] 孙正辉[1] 许百男[1] 武琛[1] 姜金利[1] 姜燕[1] 薛哲[1] 彭定伟[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华外科杂志》2014年第4期276-279,共4页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（81171109）

摘　　要：目的 分析和评价应用动脉瘤孤立联合架桥、颈内动脉近端阻断以及单纯动脉瘤孤立等方法处理巨大症状性颈内动脉海绵窦段动脉瘤的临床疗效.方法 2007年2月至2013年3月手术治疗23例巨大症状性颈内动脉海绵窦段动脉瘤患者,男性3例,女性20例;年龄24 ～68岁,平均54.7岁.术前均行数字减影血管造影（DSA）明确诊断,并行球囊闭塞试验（BOT）评价代偿情况.根据BOT的结果,分别选择了动脉瘤孤立联合高流量架桥、单纯动脉瘤孤立或颈内动脉起始端阻断治疗.患者术中进行神经电生理监测以及CT灌注成像等检查.术后定期随访复查DSA或CT血管造影.结果 17例患者进行了动脉瘤孤立联合高流量血管架桥,1例单纯动脉瘤孤立,5例为颈内动脉近端阻断.术后早期4例症状改善,9例出现新的神经功能障碍,10例患者症状同术前.2例患者失访,其余患者术后随访3～75个月;末次随访时的格拉斯哥预后评分：5分19例,3分1例,1分1例.结论 对于巨大症状性颈内动脉海绵窦段动脉瘤,根据术前BOT、术中电生理及CT灌注的充分评估结果,分别选择动脉瘤孤立联合血管架桥或单纯颈内动脉近端阻断会取得好的疗效.Objective To evaluate the management and outcomes in patients with giant symptomatic cavernous sinus aneurysms who underwent aneurysms trapping with bypass,proximal carotid occlusion and aneurysms trapping.Methods Twenty-three patients with giant symptomatic cavernous sinus aneurysms underwent surgery between February 2007 and March 2013,3 cases were male and 20 cases were female patients,the age of the patients ranged between 24 and 68 years,mean age was 54.7 years.The preoperative digital subtraction angiography （DSA） and ballon occlusion test（BOT） were performed to confirm the diagnosis and identify hemodynamic reserve with carotid occlusion,and the aneurysms trapping with bypass,aneurysms trapping and proximal occlusion of the internal carotid artery were performed according to BOT results.During the surgery,the neurophysiological monitoring and the intraoperative CT perfusion were used.The follow-up by DSA or CT angiography were made.Results Seventeen patients underwent aneurysms trapping with bypass,1 underwent aneurysms trapping and 5 underwent proximal occlusion of the internal carotid artery.After surgery,symptom improved in 4 cases,did not change in 10 cases,and new neural function deficit developed in 9 cases.The follow-up period were 3 months to 75 months.Two patients were lost.The Glasgow Outcome Scale of last follow-up were 5 in 19 patients,3 in 1 patient and 1 in 1 patient.Conclusions The aneurysms trapping with bypass aud proximal occlusion of the internal carotid artery are effective and reliable procedure for treatment of giant symptomatic cavernous sinus aneurysms in selected patients after evaluation of the pre-operative BOT,intra-operative neurophysiological monitoring and the intraoperative CT perfusion.

关 键 词：颅内动脉瘤 颈内动脉 海绵窦 神经外科手术 

分 类 号：R739.41[医药卫生—肿瘤]