多种监测辅助下头颈部联合入路夹闭颈内动脉床突旁动脉瘤的临床研究  

Clipping of paraclinoid carotid aneurysm via combined head and neck approach with assistance of multiple intraoperative monitoring:report of 35 cases

作　　者：吴欣桐 何朝晖[1] WU Xintong;HE Zhaohui(Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《第三军医大学学报》2021年第2期131-136,共6页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(81870927);重庆市自然科学基金面上项目(CSTC2019jcyj-msxmX0239)

摘　　要：目的探讨多种术中监测辅助下头颈部联合入路床突旁动脉瘤夹闭术的手术效果。方法回顾性分析重庆医科大学附属第一医院神经外科2016年1月至2019年12月在体感诱发电位(somatosensory evoked potential,SEP)、运动诱发电位(motor evoked potential,MEP)、多导皮层脑电图(multilobar electrocorticography,mEcoG)、多普勒血管超声、吲哚氰绿造影技术术中辅助下行头颈部联合入路床突旁动脉瘤夹闭术患者的临床资料,术后均行CTA或DSA评估夹闭效果,出院时采用改良Rankin评分量表(modified Rankin Scale,mRS)评估患者近期预后,并对患者进行临床观察及影像学随访以评估远期预后。结果共35例患者,术中夹闭床突旁动脉瘤35个,术后经CTA或DSA证实仅1例存在瘤颈残留,余34例患者均夹闭完全。围手术期无死亡。出院时mRS评分结果,预后良好32例,约占91%,预后不良3例,约占9%。35例患者均获得随访,随访时间为6~18(12±4)个月,根据随访资料采用mRS评分,预后良好30例,占86%,预后不良5例,占14%。结论在多种术中监测手段的辅助下,经头颈部联合入路于显微镜下夹闭床突旁动脉瘤安全可行,能获得满意的临床疗效。Objective To explore the surgical efficacy of clipping surgery for paraclinoid carotid aneurysm(PCA)via combined head and neck approach assisted by multiple intraoperative monitoring.Methods Clinical data of the PCA patients treated in our department from January 2016 to December 2019 were collected and analyzed retrospectively,who underwent clipping surgery in combined head and neck approach with the aid of monitoring of somatosensory evoked potential(SEP),motor evoked potential(MEP)and multilobar and electrocorticography(mEcoG),Doppler vascular ultrasound examination,and indole cyanogen green(ICG)imaging.Postoperative computed tomography angiography(CTA)or digital subtraction angiography(DSA)was performed to evaluate the clipping effect.The recent prognosis of the patients was evaluated at discharge with the modified Rankin Scale(mRS),and the long-term prognosis was comprehensively assessed based on the follow-up neuroimaging data and clinical observation of the patients.Results The 35 patients(11 males and 24 females,a mean age of 52.3 years)had 35 clipped PCA.Postoperative CTA or DSA confirmed that only 1 patient had residual aneurysm neck,and the remaining 34 patients obtained perfect clipping efficacy,with no death during the perioperative period.According to mRS score at discharge,32 patients had a good prognosis(91%)and 3 patients had a poor one(9%).During the 6~18 months'follow-up(12±4 months on the average),30 cases showed a good long-term prognosis(86%),while the other 5 patients had poor prognosis(14%).Conclusion With the assistance of multiple intraoperative monitoring,it is safe and feasible to implement clipping surgery for PCA under the microscope via combined head and neck approach,and satisfactory clinical efficacy can be obtained.

关 键 词：床突旁动脉瘤 夹闭手术 头颈部联合 术中监测 

分 类 号：R181.32[医药卫生—流行病学] R741.05[医药卫生—公共卫生与预防医学]