颈内动脉床突上段血泡样动脉瘤的显微手术治疗  

Microsurgery treatment for blood blister like aneurysms of the supraclinoid carotid artery

作　　者：刘坤[1] 周丹[1] 钟小康 黄红星[1] 邹叔骋[1] 罗宗晚[1] 李创华[1] 朱勇[1] 李凌[1] 刘博[1] 张卫民[1] 刘华[1] 

机构地区：[1]湖南省脑科医院神经外科,长沙410007

出　　处：《立体定向和功能性神经外科杂志》2016年第6期348-350,共3页Chinese Journal of Stereotactic and Functional Neurosurgery

基　　金：湖南省卫计委科研基金项目(编号:C2015-46);湖南省教育厅优秀青年科研项目(编号:2016-162)

摘　　要：目的探讨颈内动脉床突上段血泡样动脉瘤的显微手术策略。方法回顾性分析2010年1月至2016年6月9例血泡样动脉瘤患者的临床资料,总结经验教训。结果 9例均开颅手术,采用动脉瘤直接夹闭、动脉瘤孤立及动脉瘤包裹等方法,术后6例恢复良好,3例术后出现不同程度脑梗塞;2例调整动脉瘤夹后顺利夹闭,1例包裹加夹闭,术后脑梗塞,行去骨瓣减压;1例术中出血,包裹后去骨瓣减压后再出血死亡。术后6月随访,5例改良Rankin量表评分2分以内;1例改良Rankin量表评分3分,遗留肢体偏瘫及部分失语;1例失访;1例复发,术后多重支架加弹簧圈栓塞治愈。结论颈内动脉床突上段血泡样动脉瘤是一种特殊的颅内复杂动脉瘤,较高的复发率、高死残率,应引起重视,显微手术是一种可考虑的治疗方法,但术前侧支循环评估、精准的显微技巧、完善的术前评估、必备的设备及材料缺一不可。Objective To investigate the treatmen strategy of blood blister like aneurysmsof the supraclinoid carotid artery. Methods The clinical data of 9 cases of blood blister like aneu- rysms of the supraclinoid carotid artery underwent operation in our department from Janurary 2010 to June 2016 was analyzed retrospectively. Results 9 cases were mircrosurgical operated,6 patients recovered well postoperatively, 3 cases of postoperative appear different degree of cere- bral infarction,2 cases adjusted of aneurysm clip, 1 case cliped with packages,postoperative been cerebral infarction, to bone disc decompression, 1 case been hemorrhage twice, then died. Follow-- up of 6 months, 5 cases of modified Rankin scale score 2 points, 1 case of modified score 3 points, left limbs hemiplegia and aphasia,1 case was lost to follow-up;1 case of recurrence, cured with multiple stents and spring coil. Conclusion Blood blister like aneurysm is a special kind of corn plex intracranial aneurysm with high recurrence rate, high disability and death rate, should be taken into consideration seriously, microsurgery is a kind of treatment considered, but the preop- erative assessment of collateral circulation, accurate microscopic techniques, perfect preoperative evaluation,the necessary equipment and materials are Indispensable.

关 键 词：床突上段 血泡样动脉瘤 显微技术 

分 类 号：R739.4[医药卫生—肿瘤]