床突旁动脉瘤的显微外科手术治疗  

Microsurgical treatment of paraclinoid aneurysms

作　　者：伊志强[1] 李良[1] 刘臻 段鸿洲[1] 鲁润春[1] 李春伟[1] 张扬[1] 张家湧[1] Yi Zhiqiang;Li Liang;Liu Zhen;Duan Hongzhou;Lu Runchun;Li Chunwei;Zhang Yang;Zhang Jiayong(Department of Neurosurgery,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院神经外科,北京100034

出　　处：《中华医学杂志》2019年第4期266-271,共6页National Medical Journal of China

摘　　要：目的探讨颈内动脉床突旁动脉瘤的显微外科手术治疗策略,评价其有效性及安全性。方法回顾性分析北京大学第一医院2010年1月至2017年12月期间21例经开颅手术治疗的床突旁动脉瘤病例,共治疗床突旁动脉瘤22个,其中BaramiK分型Ⅰa型2个,Ⅰb型6个,Ⅱ型7个,Ⅲa型6个,Ⅳ型1个。17例囊性动脉瘤中,16例行动脉瘤夹闭术,1例行动脉瘤孤立+高流量搭桥。5例血泡样动脉瘤中,包裹夹闭2例,动脉瘤孤立+高流量搭桥2例,动脉瘤孤立+低流量搭桥1例。患者经数字减影血管造影(DSA)或CT血管造影(CTA)复查,门诊及电话随访。结果17例患者(18个动脉瘤)行夹闭术,瘤颈残余2例,载瘤动脉轻度狭窄2例。4例动脉瘤孤立+颅内外搭桥患者中,动脉瘤均未见显影,桥血管均通畅。动脉瘤完全闭塞率为91%(20/22)。术前8例视力障碍患者,术后视力均有好转。新发视力障碍2例。出院时格拉斯哥预后评分(GOS)5分12例,4分6例,3分2例,1分1例。结论显微外科技术开颅夹闭床突旁动脉瘤具有高闭塞率、低复发率的特点,是血管内介入治疗的合理有效补充手段。Objective To explore the microsurgical treatment of paraclinoid aneurysms and evaluate its safety and efficacy.Methods The data of 21 patients with 22 paraclinoid aneurysms receiving craniotomy between Jan.2010 and Dec.2017 in Peking University First Hospital were retrospectively analyzed.According to the Barami K classification,2 aneurysms were type Ⅰ a,6 type Ⅰ b,7 type Ⅱ,6 type Ⅲ a,1 type Ⅳ.Out of the 17 cases of saccular aneurysms,16 aneurysms were clipped and one aneurysm was trapped following high-flow EC-IC bypass.Out of the 5 cases of blood blister like aneurysms,2 aneurysms were wrap-clipped,2 aneurysms were trapped following high-flow EC-IC bypass and 1 aneurysm was trapped following STA-MCA bypass.The patients were reexamined with CT angiography (CTA) or digital subtraction angiography (DSA) aud followed up in outpatient or by phone call.Results Seventeen patients with 18 paraclinoid aneurysms had received aneurysm clipping.Aneurysmal neck remnant was found in 2 cases,parent artery stenosis was found in 2 cases.In all of the four bypass cases,graft artery patency was confirmed and no recurrence of aneurysm was observed.The obliteration rate of the paraclinoid aneurysm was 91%(20/22).Eight cases with preoperative vision defect had recovered to some extent.New vision defect occurred in two cases.At discharge,12 patients scored with Glasgow outcome scale 5,6 patients scored 4,2 patients scored 3,and one patient scored 1.Conclusion Microsurgical treatment for paraclinoid aneurysm is a safe and effective method with high aneurysm obliteration rate and low aneurysm recurrence rate,and is thus a reasonable and effective complementary method for endovascular treatment.

关 键 词：颈内动脉 眼动脉 动脉瘤 显微外科手术 

分 类 号：R651.12[医药卫生—外科学]