床突旁动脉瘤的外科治疗  

Surgical treatment of paraclinoid aneurysms

作　　者：段鸿洲[1] 李良[1] 张扬[1] 张家湧[1] 鲍圣德[1] 

机构地区：[1]北京大学第一医院神经外科,北京100034

出　　处：《北京大学学报（医学版）》2015年第4期679-684,共6页Journal of Peking University:Health Sciences

基　　金：高等学校博士学科点专项科研基金(20110001120050)资助~~

摘　　要：目的:探讨颈内动脉床突旁动脉瘤的治疗策略,评价显微外科手术及血管内介入治疗床突旁动脉瘤的疗效及安全性。方法:回顾性分析28例床突旁动脉瘤病例,共检出床突旁动脉瘤30个,其中Barami分型Ⅰa型4个,Ⅰb型5个,Ⅱ型13个,Ⅲa型4个,Ⅲb型1个,Ⅳ型3个。15例患者行显微手术治疗,共处理床突旁动脉瘤17个,其中有3例采用血管搭桥+动脉瘤旷置术。13例患者行血管内介入治疗(1例复发后改行显微外科手术治疗),其中3例患者采用球囊辅助栓塞,3例患者采用支架辅助栓塞。结果:28例患者共处理床突旁动脉瘤30个。15例显微外科手术治疗患者,术后出现视力下降1例,术后10 d突发意识不清死亡1例;13例血管内介入治疗患者,术后脑血管痉挛、脑梗死、对侧肢体轻瘫1例,2例患者出现交通性脑积水,行分流术后好转。术后复查造影19例,10例显微外科手术治疗组患者中夹闭完全9例,9例血管内介入治疗组患者中弹簧圈完全栓塞7例,1例支架辅助栓塞后12个月动脉瘤复发增大,改行颞浅动脉-大脑中动脉吻合,双侧大脑前动脉吻合,动脉瘤旷置术。28例患者出院时格拉斯哥预后评分(Glasgow outcome scale,GOS)5分18例,4分8例,3分1例,0分1例。结论:选择合适的病例,显微外科手术及血管内介入治疗床突旁动脉瘤均可获得良好的治疗效果。Objective： To explore the surgical treatment of paraclinoid aneurysms and evaluate the safety and efficacy of microsurgical clip and endovascular embolization of paraclinoid aneurysms. Methods：The data of 28 patients with 30 paraclinoid aneurysms receiving surgical treatment were retrospectively analyzed. According to Barami classification,4 aneurysms were type Ⅰa,5 aneurysms type Ⅰb,13 aneurysms type Ⅱ,4 aneurysms type Ⅲa,1 aneurysm type Ⅲb,and 3 aneurysms type Ⅳ. In the study,15 cases with 17 paraclinoid aneurysms received microsurgical treatment,of which 3 cases underwent superficial temporal artery-middle cerebral artery（ STA-MCA） bypass firstly and then aneurysms were trapped. The other 13 cases received endovascular embolism,in which balloon assistant technology was performed in 3 cases and stent assistant technology in another 3 cases. Results： All the 30 paraclinoid aneurysms were treated. One patient with bilateral paraclinoid aneurysms became blind after bilateral microsurgical procedures and another patient was unexceptedly dead 10 d after operation. Vasospasm resulting with cerebral infarction occurred in one case who received endovascular embolism,while two patients suffered from hydrocephalus. Ten cases of microsurgical group and 9 cases of interventional group were followed up with digital subtraction angiography,which disclosed that 9 cases of microsurgical group were clipped completely,while 7 aneurysms of interventional group were completely embolised. One aneurysm recurred and enlarged 12 months after stent assistant embolism,and after STA-MCA bypass and bilateral anterior cerebral artery anastomy and aneurysm insulation,the patient recovered well. When the patients were discharged,their Glasgow outcome scales showed that 18 cases were with 5,8 with 4,1with 3 and 1 with 0. Conclusion： According to the classification,and with appropriate treatment,the patients with paraclinoid aneurysms will get good outcomes both with microsurgical clipping and with endovascular emboliza

关 键 词：动脉瘤 颈内动脉 显微外科手术 血管内手术 

分 类 号：R651.122[医药卫生—外科学]