海绵窦段颈内动脉瘤

目的：探讨海绵窦段颈内动脉瘤的发生机理、临床表现及诊断治疗。方法：12例病人应用微导管插管技术．在数字减影脑血管造影(DSA)监视下，用球囊对海绵窦段颈内动脉瘤行血管内栓塞治疗。结果：12例病人均一次栓塞成功，栓塞后症状消失，其中4例病人视力改善，2例失明病人视力分别恢复至0．1及0.3。1例于栓塞后1年出现患侧末梢血管脑梗塞，表现为对侧肢体瘫痪，积极治疗后恢复。结论：应用可脱性球囊血管内栓塞动脉瘤近端载瘤动脉是治疗本病的有效手段。     

动脉瘤性颈内动脉海绵窦瘘的血管内治疗

目的总结应用血管内技术治疗颈内动脉海绵窦段动脉瘤破裂导致颈内动脉海绵窦瘘(CCF)的经验体会。方法回顾性分析8例颈内动脉海绵窦段动脉瘤破裂致CCF患者的临床资料以及应用的血管内技术,其中单纯应用可脱球囊治疗1例,弹簧圈结合可脱球囊进行治疗2例,球囊辅助弹簧圈栓塞治疗2例,覆膜支架治疗1例。结果8例患者中6例治疗成功,无技术相关性并发症;1例治疗前突然死亡;1例放弃治疗。结论血管内技术是治疗颈内动脉海绵窦段动脉瘤破裂致CCF的安全、有效方法。     

应用水膨胀式微弹簧圈栓塞治疗外伤性颈动脉海绵窦瘘

目的总结水膨胀式微弹簧圈（HydroCoil）栓塞治疗颈动脉海绵窦瘘（CCF）的初步体会，对HydroCoil治疗CCF的有效性作出评价。方法选取我院2006年1月以来应用HydroCoil栓塞系统治疗14例外伤性颈动脉海绵窦瘘（CCF）病人，男9例，女5例，平均26．5岁。脑血管造影显示6例瘘口位于右侧颈内动脉海绵窦段，8例位于左侧颈内动脉海绵窦段。结果14例病人CCF术后均不再显影，患侧颈内动脉通畅，所有病人术前的颅内杂音、突眼和球结膜充血等症状在1周内恢复正常，视力也有不同程度的恢复。8例病人术后获得1—3个月脑血管造影随访，CCF均未见复发。没有神经系统并发症发生。结论血管内介入治疗已经广泛应用于颈动脉海绵窦瘘，可脱球囊栓塞仍为首选方法。当病人不能耐受或不允许闭塞患侧颈内动脉时，可以选用HydroCoil。HydroCoil治疗CCF安全、有效、稳定，颈动脉保持通畅率高，长期临床效果仍有待于进一步研究。     

复杂性颅内动脉瘤的血管内治疗

目的 探讨复杂性颅内动脉瘤血管内治疗方法的选择及其效果评价.方法 对2005年1月～2007年1月收治的经DSA确诊的复杂性颅内动脉瘤12例进行了经皮穿刺血管内治疗,其中椎动脉瘤1例,基底动脉瘤4例,后交通动脉瘤1例,眼动脉瘤2例,颈动脉海绵窦段动脉瘤2例,前交通动脉瘤2例,分别采用了球囊,GDC,水解弹簧圈,Neuroform支架辅助水解弹簧圈或GDC栓塞技术.其中1例眼动脉瘤合并颈动脉海绵窦动静脉瘘,1例颈动脉海绵窦段动脉瘤破裂引起海绵窦动静脉瘘合并大脑中动脉动静脉瘘.结果 8例100%弹簧圈致密填塞,2例95%以上填塞,1例获90%填塞,1例行球囊动脉瘤栓塞术.1例眼动脉瘤因发生颈内动脉斑块脱落于大脑中动脉术后出现脑梗塞灶引起肢体偏瘫,经治疗后好转;1例眼动脉瘤行球囊动脉瘤栓塞术3月后复发,因经济困难而行开颅手术治疗,其余病例血管内治疗术后临床症状消失或好转.12例随访3月-24个月,无再出血或症状加重.结论 血管内治疗是复杂性颅内动脉瘤治疗的主要方法之一,只要选择合适的病例及适当的栓塞技术和栓塞材料,将会获得满意的临床效果.但血管内治疗仍然有与栓塞技术及材料相关的并发症,长期疗效有待于进一步随访.     

血管吻合联合颈内动脉闭塞治疗海绵窦段巨大梭形动脉瘤2例

目的总结颈内动脉海绵窦段巨大梭形动脉瘤的的治疗方法。方法2例颈内动脉海绵窦段巨大梭形动脉瘤术前造影均存在交叉循环不良,行Matas试验均不能耐受,故先行颞浅动脉-大脑中动脉吻合术以增加脑供血。1例术后可以耐受颈内动脉阻断,行球囊闭塞颈内动脉治疗;另1例仍不能耐受Matas试验,采用逐渐阻断夹夹闭颈内动脉的方法治疗。结果2例术后症状消失治愈,随访8个月～1.5年生活良好。结论对海绵窦段巨大动脉瘤,可采取间接手术包括阻断动脉瘤近侧段载瘤动脉,促使动脉瘤内血栓形成以闭塞动脉瘤的方法治疗。若术前交叉循环造影示侧支循环不良,可先行颅内-颅外血管吻合以增加侧支供血,再用球囊或手术将载瘤动脉近段闭塞。     

创伤性假性动脉瘤与动静脉瘘血管内治疗研究

1979年以来,对118例病人,其中颈内动脉一海绵窦瘘88例、动静脉瘘8例、假性动脉瘤22例采用了血管内治疗:①可脱性球囊栓塞64例:②弹簧圈栓塞19例;③钨丝螺旋圈栓塞15冽;④肌瓣“放风筝”法治疗6例:⑤眼上静脉穿刺注入栓塞材料2例;⑥瘤腔直接穿刺注入栓塞材料2例;①气囊导管暂时阻断动脉腔内血流与血管重建相结合治疗10例.2例颈内动脉-海绵窦瘘病人术后出现偏瘫,在半年内恢复,余皆治愈.     

颅内动脉瘤的血管内球囊栓塞治疗(附五例报告)

本文报告5例颈内动脉海绵窦段动脉瘤应用可脱性球囊治愈。球囊均在动脉瘤前方闭塞颈内动脉。侧支循环代偿良好,仅1例在栓塞后第5天发生偏瘫,球囊并未移位。本文讨论了迟发性偏瘫的原因及术后处理,特别强调了扩容治疗的重要性。     

创伤性颈动脉海绵窦瘘介入治疗的临床效果影响因素分析

目的研究影响外伤性颈动脉海绵窦瘘(TCCF)血管内栓塞治疗效果的因素.方法对116例TCCF病人的临床资料、治疗方法及随访结果进行统计分析.结果 [1]左侧颈内动脉通畅率为96.3%,右侧79.4%,两者有显著性差异(P＜0.01).②侧别、球囊1号和球囊2号3个因素对病人颈内动脉通畅有显著性影响(P＜0.05).[3]压迫颈总动脉不利于搏动性突眼的恢复(P＜0.05).结论①左侧颈内动脉通畅率明显高于右侧.[2]侧别、球囊1号和球囊2号是影响TCCF血管内栓塞治疗后颈内动脉通畅的主要因素.[3]搏动性突眼的恢复与压迫颈总动脉有关.     

10例外伤性颈动脉海绵窦漏诊治经验

目的探讨外伤性颈内动脉海绵窦瘘（TCC）的诊断和血管内治疗的效果。方法2003年1月至2011年10月经血管内栓塞治疗TCCF病人10例,其中8例用可脱卸球囊栓塞治疗,2例用微弹簧圈栓塞治疗。结果10例病人均栓塞成功,并保持颈内动脉通畅,1例术后2周复发并视力受损,给予ONXY胶栓塞治愈,所有病人的临床症状改善显著。结论血管内可脱性球囊栓塞是治疗TCCF的首选方法;对球囊栓塞失败或难度大的病例,弹簧圈和ONXY胶在一定程度上可以弥补球囊的不足,取得较好的临床效果。     

小脑血管母细胞瘤合并颈内动脉海绵窦段动脉瘤1例报告并文献复 习简

目的总结1例小脑血管母细胞瘤合并颈内动脉海绵窦段动脉瘤病例的治疗经验。方法回顾性分析l例小脑血管母细胞瘤合并颈内动脉海绵窦段动脉瘤病人的临床资料。采用枕下后正中至左外侧入路开颅,显微外科技术全切除肿瘤。无症状的海绵窦段动脉瘤未给予治疗。结果病理证实：血管母细胞瘤。术后MRJ示：肿瘤全切除。术后1年随访：病人恢复良好,颈内动脉海绵窦段动脉瘤未见增大及破裂出血,继续随访观察。结论血管母细胞瘤合并颅内动脉瘤病例少见,对于未破裂非供瘤动脉动脉瘤,可以随访监测动脉瘤的变化,结合显微神经外科技术切除血管母细胞瘤可获得较好的预后。     

单侧颈动脉结扎治疗海绵窦段动脉瘤(附15例报告)

目的回顾性分析15例单侧颈动脉结扎治疗海绵窦段动脉瘤患者病历资料,探讨颈动脉结扎的适应证、术前准备、手术方案选择、术后并发症的防治。方法 15例患者均为DSA证实的海绵窦段动脉瘤患者,其中 11例为海绵窦段巨大动脉瘤,4例为创伤性动脉瘤,术前行马它氏试验2周以上,9例为缓慢夹闭颈内动脉再行颈内动脉结扎术,2例行直接结扎颈内动脉,4例行直接结扎颈总动脉。8例术中术后行Doppler监测,全部病例术后行心电、血压等监护。结果 15例患者中,术后2例出现并发症,1例为术后第5周缓慢出现对侧肢体偏瘫,1例为术后 4h出现意识变差,肢体活动障碍,而行急诊手术再次开放颈内动脉,但术后患者仍有偏瘫。结论缓慢夹闭颈内动脉是治疗海绵窦段动脉瘤的一种可行方法。     

颅内外搭桥治疗海绵窦段动脉瘤

目的 结合文献对海绵窦段颈内动脉瘤的手术方式、手术指证及影响疗效的因素进行分析.方法 13例海绵窦段动脉瘤患者,其中大型、巨型动脉瘤12例,中型1例.13例均行颅内外高流量搭桥及动脉瘤孤立术.结果 术后检查搭桥血管12例通畅,1例闭塞.8例术后无神经功能障碍加重.5例术后出现严重并发症,其中2例恢复到GOS评分4分,3例3分.动脉瘤均不显影,CT上可见血栓形成.结论 颅内外搭桥辅助下颈内动脉海绵窦段动脉瘤孤立术是治疗颅内巨大动脉瘤的较好方法.     

Strategy for the treatment of inaccessible unruptured giant and large aneurysms of the internal carotid artery

Abstract

Our goal was to clarify the optimum management of the inaccessible unruptured giant and large aneurysms of the internal carotid artery (ICA). Since 1981, we have treated 18 patients with unclippable unruptured giant or large aneurysms of the ICA. Aneurysms were classified as either intracavernous or intradural. We performed proximal carotid occlusion in 12 patients and conservatively treated six patients. We retrospectively analyzed long-term outcomes in these patients. Four of seven patients with intradural aneurysm underwent proximal carotid occlusion, with good long-term outcomes. The three patients with intradural aneurysm, who were treated conservatively, died of subarachnoid hemorrhage. Eight of 11 patients with intracavernous aneurysm underwent proximal carotid occlusion, one dying of massive nasal bleeding 25 months after the procedure. In this case, the aneurysm was partially thrombosed, and residual lumen growth was revealed 22 months after proximal carotid occlusion. Cranial nerve paresis improved in five of the eight patients (63%), and two patients had a minor ischemic attack. Neurological problems failed to occur in the three patients with intracavernous aneurysm who were treated conservatively. The risk of rupture is relatively high in intradural giant and large aneurysms. Proximal carotid occlusion can effectively prevent bleeding from intradural aneurysms. Aggressive management is justified for intradural aneurysms with poor collateral circulation. Operative procedures in the management of an intracavernous aneurysm require careful consideration.     

Strategy for the treatment of inaccessible unruptured giant and large aneurysms of the internal carotid artery.

Our goal was to clarify the optimum management of the inaccessible unruptured giant and large aneurysms of the internal carotid artery (ICA). Since 1981, we have treated 18 patients with unclippable unruptured giant or large aneurysms of the ICA. Aneurysms were classified as either intracavernous or intradural. We performed proximal carotid occlusion in 12 patients and conservatively treated six patients. We retrospectively analyzed long-term outcomes in these patients. Four of seven patients with intradural aneurysm underwent proximal carotid occlusion, with good long-term outcomes. The three patients with intradural aneurysm, who were treated conservatively, died of subarachnoid hemorrhage. Eight of 11 patients with intracavernous aneurysm underwent proximal carotid occlusion, one dying of massive nasal bleeding 25 months after the procedure. In this case, the aneurysm was partially thrombosed, and residual lumen growth was revealed 22 months after proximal carotid occlusion. Cranial nerve paresis improved in five of the eight patients (63%), and two patients had a minor ischemic attack. Neurological problems failed to occur in the three patients with intracavernous aneurysm who were treated conservatively. The risk of rupture is relatively high in intradural giant and large aneurysms. Proximal carotid occlusion can effectively prevent bleeding from intradural aneurysms. Aggressive management is justified for intradural aneurysms with poor collateral circulation. Operative procedures in the management of an intracavernous aneurysm require careful consideration.     

MRI localization of paraclinoid carotid aneurysms

AIM: The distal dural ring plane (DDRP) separates the intracavernous from the supracavernous paraclinoid internal carotid artery. The purpose of this MRI protocol is to evaluate the position of this plane for the characterization of paraclinoid aneurysms. METHOD: The protocol uses a T2 weighted sequence in two orthogonal planes (diaphragmatic and carotid planes) and two correlation lines in each plane. These lines pass through anatomo-radiological reference points correlated with the medio-lateral and antero-posterior margins of the DDRP. We use the intersection angle of these lines as the inferior radiological limit of the DDRP curve. RESULTS: An aneurysm located above this angle is supracavernous; an aneurysm located below this angle is intracavernous; an aneurysm crossing this angle is transitional. CONCLUSION: In difficult cases, this MRI protocol could help better characterize the exact localization of paraclinoid aneurysms on both sides of the cavernous sinus roof.     

Giant parasellar aneurysm simulating pituitary tumor

Seven cases of compromised pituitary fossa at the conventional skull X-ray, who had the final diagnosis of giant aneurysm of the intracavernous portion of the carotid artery (6 cases) and one of the anterior communicating artery, are reported. The main findings were: headache (7/7), complex ophthalmoplegia involving the III, IV and VI cranial nerves (5/7), compromised V cranial nerve (4/7) and eyeball pain (4/7). Other manifestations were: meningeal signs (2/7), unilateral blindness (1/7), hemiparesis (1/7), cacosmia (1/7) and inferior bitemporal quadrantanopsia (1/7). Five patients with intracavernous carotid artery aneurysm showed benefits with progressive occlusion of the internal carotid artery at the cervical level. One died before surgery. The case with anterior communicating artery aneurysm improved after its surgical clipping. Our data, in accord with the literature, support the conclusion that the differential diagnosis of aneurysms in the parasellar region remains a very difficult task. The accurate final diagnosis requires cerebral angiography and the surgical treatment with progressive occlusion at the cervical portion of the internal carotid artery has a relatively low risk with promising results.     

Surgical treatment of transitional internal carotid aneurysms.

Ten transitional internal carotid aneurysms are presented. Necks and domes of these aneurysms were located in both the intradural subarachnoid and extradural intracavernous spaces across the carotid dural ring. Seven aneurysms were small, 2 were large, and 1 was giant. Two patients had subarachnoid haemorrhage (SAH), 2 compressive symptoms, 5 SAH from rupture of associated lesions (aneurysms or AVM) and 1 case was an incidental finding. Direct clipping was performed successfully in all patients. The overall surgical outcome was excellent in all patients, with transient complications in 4 cases. It is suggested these aneurysms should be treated with direct clipping whether ruptured or not because of the risk of SAH. A classification of paraclinoidal region aneurysms including cavernous sinus aneurysms extending into the intradural subarachnoid space is proposed.     

Willis覆膜支架治疗颈内动脉血泡样动脉瘤的疗效分析

目的 探讨Willis覆膜支架治疗颈内动脉血泡样动脉瘤（BBA）的安全性和有效性。方法 回顾性分析2015年12月至2019年1月采用Willis覆膜支架治疗的15例颈内动脉BBA的临床资料。结果 15例共用16枚支架，均成功置入载瘤动脉。术后即刻造影动脉瘤均不显影，1例术中破裂出血，1例围手术期出血，1例围手术期急性支架内血栓形成。12例进行造影随访，13例临床随访；随访时间3~30个月，平均12.1个月；10例动脉瘤完全不显影，载瘤动脉通畅；1例术后3个月原动脉瘤部位局部膨出，1例术后26个月CTA示左侧颈内动脉闭塞，没有神经功能的受损；mRS评分0分11例，1分1例，5分1例。结论 Willis覆膜支架治疗颈内动脉BBA是安全有效的，尚需更长时间的随访和较大样本的随机对照研究来证实     

Intracavernous internal carotid artery mycotic aneurysms: Comprehensive review and evaluation of the role of endovascular treatment

Mycotic aneurysms may arise in the setting of many local or systemic infections. Those of the intracranial circulation are especially worrisome due to their potential to compress vital neural structures and their propensity for rupture with consequent hemorrhage. Mycotic aneurysms of the intracavernous internal carotid artery (ICA) represent an exceedingly rare clinical entity, described in less than fifty published cases. Typically presenting as a cavernous sinus syndrome with signs and symptoms of the underlying infection, they are often missed initially, with diagnosis and treatment commencing for the triggering infection or confused with cavernous sinus thrombophlebitis, which may be additionally coexistent, confounding timely diagnosis of the aneurysmal disease. Compared to non-mycotic aneurysms of the intracavernous ICA, which typically have a benign course, the infectious etiology of the mycotic variety increases their tendency to rupture, precludes surgical clipping as a viable treatment option, and requires institution of prolonged antibiotic therapy prior to definitive intervention. Their critical location, friability, and propensity to occur bilaterally result in an unpredictable risk of rapid neurological decline and death, making the timing and specific nature of treatment a unique dilemma facing the treating physician. This review seeks to discuss the natural history of and management strategies for mycotic aneurysms of the intracavernous ICA with special emphasis on the role, safety, and efficacy of endovascular therapies.     

海绵窦及床突旁大型和巨大型动脉瘤的手术治疗

目的 探讨海绵窦和床突旁大型、巨大型动脉瘤的特点、手术适应证及手术方法.方法 1998至2006年对36例床突旁和海绵窦大型、巨大型动脉瘤经外科于术治疗.常规采取翼点入路,暴露颈部颈内动脉.分别采用动脉瘤直接夹闭,动脉壁修补及动脉瘤孤立加颅内外血管搭桥等方式处理动脉瘤.术中使用脑电图(EEG)及体感诱发电位(SEP),以及多普勒(Doppler)、内镜等辅助设备.结果 32例床突旁动脉瘤直接夹闭,1例海绵窦内假性动脉瘤行载瘤动脉修补术,3例海绵窦动脉瘤行孤立加颅内外血管搭桥术.出院时GOS评分良好者32例(89%),重残2例(5.6%),死亡2例(5.6%).结论 不适宜栓塞治疗的海绵窦动脉瘤应采取手术治疗,而床突旁动脉瘤则首选手术治疗.