逆向抽吸减压法在颈内动脉大型及巨大型动脉瘤夹闭术中的应用

目的 探讨逆向抽吸减压法在颈内动脉大型及巨大型动脉瘤夹闭术中的优点及其风险.方法 回顾性分析逆向抽吸减压法在26例颈内动脉大型及巨大型动脉瘤夹闭术中的应用及疗效.结果 26例动脉瘤术中均成功夹闭,术后3D-CTA或DSA复查均提示动脉瘤完全夹闭,载瘤动脉通畅,术后均未出现植物生存状态或死亡.结论 逆向抽吸减压法在颈内动脉大型及巨大型动脉瘤夹闭术中能有效地缩小动脉瘤的体积,有利于动脉瘤的剥离和夹闭方案.

Abstract：

Objective To present our experience with retrograde suction decompression in clipping of large and giant internal carotid artery aneurysms and analyze its advantages and pitfalls.Methods A retrospective analysis of 26 large and giant intracranial aneurysms treated by suction decompression assisted clipping between November 2005 and February 2010 was present.The surgical techniques and the outcome of patients were reviewed.Results All aneurysms were successfully clipped, and postoperative 3D - CTA or DSA revealed no major branch occlusion or residual aneurysm.There was no surgical mortality in both giant and large aneurysm groups.Conclusions Retrograde suction decompression is a successful adjunct to clipping of large and giant internal carotid artery aneurysms.     

颅内镜像动脉瘤17例临床分析

目的 探讨颅内镜像动脉瘤的临床特征和手术方法.方法 解放军第二五一医院神经外科自2006年1月至2010年6月行显微外科手术治疗颅内镜像动脉瘤患者17例,回顾性分析患者的临床资料和疗效.结果 本组动脉瘤直接夹闭35个,未作处理1个,患者行一期手术9例,夹闭动脉瘤20个.二期手术7例,第一次手术夹闭动脉瘤7个,第二次手术夹闭动脉瘤7个.1例患者行一侧动脉瘤夹闭后对侧动脉瘤未处理;11例患者术后行CTA复查,夹闭的23个动脉瘤中2例瘤颈残留,余动脉瘤均消失,载瘤动脉通畅.GOS评分显示恢复优良12例,轻残4例,重残1例.结论 显微外科手术治疗颅内镜像动脉瘤效果显著.正确判断责任动脉瘤并首先处理,根据动脉瘤的部位、Hunt-Hess临床分级及患者周身状况等选择一期、分期手术可达到良好效果.

Abstract：

Objective To study the clinical characteristics and microsurgical skills of intracranial mirror-image aneurysm. Methods The clinical data and post-operative outcomes of 17 patients with 36 intracranial mirror-image aneurysms who underwent microsurgical operation were analyzed retrospectively. Results Thirty-five aneurysms were clipped directly and 1 did not give any treatment. One-time surgery was performed in 9 patients and 20 aneurysms were clipped. Two-stage operation was performed in the other 7 patients: 7 aneurysms were clipped in the first surgery and 7 in the second one. One patient received aneurysm clipping only in one side of the brain. CTA was performed again on 11 patients, noting that residual aneurysm neck of the 2 aneurysms existed in 23 clipped aneurysms, that the other aneurysms disappeared, and that the parent arteries were clear. GOS indicated that good surgical outcomes were achieved in 12 patients, light disability in 4 and severe disability in 1.Conclusion The surgical outcomes of intracranial mirror-image aneurysm performed microsurgical operation are predominance. Criminal aneurysms should be determined correctly and clipped firstly; and according to the sites and grades of the aneurysms and the patient's condition, good outcomes can be achieved by choosing one-time operation or two-stage operation.     

颈宽角——一个描述颅内动脉瘤瘤颈与载瘤动脉关系的概念

目的 报告一个描述颅内动脉瘤弧形瘤颈侵及、占据或涉及(以下称侵及)载瘤动脉圆周情况的新概念--"颈宽角",并探讨其指导动脉瘤血管内栓塞治疗的意义.方法 在载瘤动脉横断面像上,将载瘤动脉壁所构成的图形概括为圆;在此圆上,将动脉瘤瘤颈所侵及的载瘤动脉壁所对应的圆心角定义为颈宽角.回顾近期采用支架内球囊再塑形技术辅助微弹簧圈栓塞治疗的8例宽颈动脉瘤的颈宽角估测结果,结合其影像、栓塞情况,分析颈宽角概念的科学性、必要性、可行性和实用性.结果 8例动脉瘤的颈宽角均大于90°,其角度区间为:90°～135°有4例,136°～180°有2例,181°～225°有1例,226°～270°有1例.8例动脉瘤均采用支架内球囊再塑形技术辅助微弹簧圈而成功栓塞,填入的微弹簧圈边缘在瘤颈部呈弧形,相应的载瘤动脉壁被重建,瘤颈部栓塞满意.结论 颈宽角概念能够表达颅内动脉瘤,特别是一些无颈或梭形动脉瘤弧形瘤颈侵及载瘤动脉的情况,有助于其血管内治疗方法的选择.

Abstract：

Objective To describe a geometric parameter for delineating the extent to which the parent artery is incorporated by the aneurysm neck, and to investigate the application of this parameter in endovascular treatment of intracranial aneurysm.Method In the 2D cross-section image obtained from the digital subtract angiography which containing simultaneously the aneurysm neck and the parent artery, the vessel lumen boundary of the parent artery is idealized to be a circle and two boundary points were thus determined in this circle where the aneurysm neck incorporating with the parent artery.The central angle formed by these two points and the circle center was defined as the arcuate neck angle, a new geometric parameter.Eight intracranial aneurysms embolized by utilizing the balloon-in-stent technique were reviewed for their measurement results of the arcuate neck angle, as well as their imaging and endovascular therapeutic data.The feasibility and practicability of utilizing this geometric parameter in endovascular treatment was investigated.Results The arcuate neck angle was more than 90° in all eight aneurysms.The measurement detail was as the following: more than 90° and less than or egual to 135° in four intracranial aneurysms,more than 135° and less than or egual to 180° in two,more than 180° and less than or egual to 225° in one, more than 225° and less than or egual to 270° in one aneurysm.These aneurysms were all successfully coil embolized.The margin of coil mass at the aneurysm neck appeared to be an arc, where the vessel wall of parent artery was reconstructed, and the aneurysm neck was also satisfactorily occluded for all cases.Conclusions The arcuate neck angle of intracranial aneurysms may approximately represent the extent to which the parent artery is incorporated by the aneurysm neck, especially for some fusiform ones or those without neck.It may benefit the optimization of endovascular therapy for intracranial aneurysms.     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

以缺血为首发症状的脑动脉瘤的诊断与治疗

目的探讨以脑缺血发作为首发症状的颅内动脉瘤的诊断与治疗。方法回顾性分析4例以脑缺血发作为首发症状的颅内动脉瘤的临床资料。1例行动脉瘤夹闭并载瘤动脉重建术，2例行动脉瘤孤立术，1例行支架辅助弹簧圈栓塞治疗。结果4例均是血栓性巨大动脉瘤。术后4例患者脑缺血症状均得到明显改善。结论以脑缺血为首发症状的颅内动脉瘤都是血栓性巨大动脉瘤，应在术前制定个性化治疗方案，积极进行外科手术或栓塞治疗，可明显改善脑缺血的发作，避免动脉瘤破裂。     

血管内治疗颅内巨大动脉瘤(附40例报告)

目的探讨颅内巨大动脉瘤的血管内治疗方法，并对疗效进行评价。方法对40例颅内巨大动脉瘤行血管内治疗，其中33例行载瘤动脉闭塞术．5例行动脉瘤栓塞术，2例行颞浅-大脑中动脉搭桥术后闭塞载瘤动脉。结果载瘤动脉闭塞术后死亡3例，动脉瘤栓塞术后死亡1例．其余病人临床状况良好。临床随访28例，状况均良好；CT随访18例，示8例动脉瘤缩小或消失；造影随访15例．示9例动脉瘤不显影．3例瘤体缩小，2例载瘤动脉再通，1例栓塞后动脉瘤复发。结论对于手术罔难的颅内巨大动脉瘤，血管内治疗是一种安全、有效的方法。     

颅内后循环动脉瘤的手术治疗(附17例报告)

目的 报告颅内后循环动脉瘤的手术治疗和临床效果。方法 对17例颅内后循环动脉瘤施行显微外科手术。术中应用脑保护剂和血管临时阻断技术，1例采用低温停循环。结果 本组动脉瘤位于基底动脉分叉部及其分支12例，椎基底动脉结合部2例，小脑后下动脉3例。17例中，巨型动脉瘤7例，梭状或半梭状动脉瘤9例。10例行动脉瘤夹闭，5例行孤立，1例行包裹，1例行载瘤动脉近端阻断。手术后早期结果好11例，差5例，死亡例。经术后3个月至8年随访结果好14例，差1例，死亡1例。结论 后循环动脉瘤需要选择合适的手术入路，充分地显露动脉瘤和载瘤动脉，术中合理应用血管临时阻断和脑保护技术以及低温停循环。对于窄颈的中小型动脉瘤可以选择血管内栓塞，但对宽颈或不规则型巨大动脉瘤应采用积极的手术治疗。     

颈内动脉巨大动脉瘤的血管内治疗

目的探讨血管内栓塞方法治疗颈内动脉巨大动脉瘤的效果和安全性。方法回顾性分析3例应用弹簧圈进行瘤腔内栓塞和27例应用载瘤动脉闭塞方法治疗的颈内动脉巨大动脉瘤的结果和随访资料。结果2例瘤腔内栓塞动脉瘤的患者症状完全消失;1例患者出现缺血性并发症,半年后随访动脉瘤再通。球囊闭塞载瘤动脉的患者1例出现迟发缺血性症状;1例吻合支开放,3个月后患者出血死亡;其余患者症状均有不同程度改善。结论颅内巨大动脉瘤是否进行瘤囊内弹簧圈栓塞需要综合考虑各种条件,采用个体化的治疗方案。球囊闭塞载瘤动脉是比较安全有效的方法。     

存在瘤内血栓的颅内大型动脉瘤的手术治疗

目的探讨伴有瘤内血栓的颅内大型或巨大型动脉瘤的诊断和手术治疗。方法本组瘤内有陈旧性血栓的颅内大型动脉瘤62例,其中行动脉瘤瘤颈夹闭或塑型夹闭47例,动脉瘤孤立术13例,动脉瘤部分切除后缝合瘤壁重建载瘤动脉1例,另1例双侧椎动脉汇合处巨大梭形动脉瘤在深低温、停循环技术辅助下行载瘤动脉重建手术。结果根据GOS评分,病人恢复良好51例(82.3%),中残4例(6.5%),重残2例(3.2%),死亡5例(8.1%)。中、重残病例随访一年以上,中残的4例中3例恢复术前生活能力;重残的2例中,1例因大面积脑梗死、偏瘫仅有部分恢复,另1例深低温、停循环辅助手术病例,手术后2d内意识清楚,但术后13个月因肝功能衰竭死亡。结论颅内血栓性大型或巨大型动脉瘤手术处理困难,致残率及死亡率高于同类型无血栓的颅内动脉瘤。载瘤动脉暂时性阻断、动脉瘤切开血栓清除均有助于瘤颈夹闭。     

颅内巨大动脉瘤的显微手术治疗效果及远期随访

目的探索颅内巨大动脉瘤的手术治疗效果及远期预后情况。方法 我科行显做手术治疗的28例颅内巨大功脉瘤患者中,行动脉瘤颈夹闭并载瘸动脉塑形者24例,行动脉瘤孤立并血管重建术者1例,行动脉瘤包裹术者3例。结果患者出院时按COS评分,Ⅴ级17例,Ⅳ级5例,Ⅲ级3例,Ⅰ级3例。术后随访9月～8年,Ⅴ级17例,Ⅳ级5例,Ⅲ级1例,Ⅰ级5例,总有效率（Ⅴ级＋Ⅳ级）78．6％（22／28）,死亡率17．9％（5／28）。结论颅内巨大动脉瘤的外科手术死亡率和致残率仍较高,对其治疗方式值得深入总结和探讨,以促进神经功能缺损的远期恢复,降低患者的致残率及术后再发风险,提高患者生存质量。     

颅内蛇形动脉瘤的外科治疗（附21例报告）

目的 探讨蛇形动脉瘤的手术治疗方法。方法 21例蛇形动脉瘤中,14例未破裂动脉瘤,主要症状为头痛4例、可逆性脑缺血发作3例、颈项强直和后组脑神经压迫5例、视野缺损1例、癫痫发作1例;有动脉瘤破裂的7例中,Hunt - Hess Ⅰ级和Ⅱ级6例、Ⅲ级1例。病程从20d至3.5年,平均7.3个月。动脉瘤位于大脑中动脉M1段6例,M2段近端4例;大脑前动脉A1段1例,A.2段近端1例;大脑后动脉P1段2例;基底动脉主干2例,椎动脉5例。动脉瘤直径0.3 ～2.5 em,平均1.2 cm。13例动脉瘤长3.0 cm以上,8例动脉瘤长5.O cm以上。桡动脉移植搭桥7例,颞浅动脉搭桥6例,枕动脉搭桥6例,大隐静脉移植搭桥2例。12例为颅内外动脉搭桥,供血动脉为颈外动脉5例,枕动脉4例,颌内动脉3例。接受动脉为大脑中动脉5例,小脑后下动脉3例,大脑后动脉P2段3例,小脑前下动脉1例。9例为动脉瘤近端与远端间的血管间插入移植搭桥,包括大脑中动脉M1与M2段间的插入移植搭桥3例,M1段间的搭桥2例,大脑前动脉A1远端与A2近端插入搭桥2例,椎动脉颅内与颅外端间搭桥2例。在搭桥外血管完毕后,11例行动脉瘤孤立术;7例行动脉瘤切除;3例仅将动脉瘤近心端阻断,保护穿通动脉开通,避免缺血发生。结果 20例术后恢复良好,包括头痛缓解,癫痫局部发作或大发作消失,肢体活动障碍的改善和视力的恢复。1例出院时需要照顾。术后脑血管造影检查,19例移植搭桥血管畅通,动脉瘤消失;1例吻合血管未通,但无神经功能缺失表现;1例颅内外搭桥后,术后第2天手术部位出现血肿,手术清除血肿,术后肢体肌力Ⅳ级。结论 对于单纯手术无法夹闭的蛇形动脉瘤,通过适当血管搭桥或插入性移植的方法可得到满意的效果。     

颅内血栓性动脉瘤的手术治疗

目的探讨血栓性动脉瘤的分类、手术指征及手术策略。方法手术治疗血栓性动脉瘤48例，其中同心型13例，偏心型27例，分叶型2例，管道型4例，“弹簧圈”型2例。动脉瘤位于海绵窦内2例，床突旁段14例，床突上段13例，大脑前动脉瘤4例，大脑中动脉瘤8例，椎基底动脉瘤7例。手术方式包括动脉瘤直接夹闭18例，血栓切除加载瘤动脉塑形21例，动脉瘤孤立加血管重建7例，其他2例。结果45例术后复查DSA示动脉瘤均消失，重建血管通畅。44例症状较术前改善。2例昏迷，1例完全性偏瘫．1例死亡。随访2个月～4年，GOS评分4～5分者39例。结论判断动脉瘤内血栓情况有利于手术方案的制定；动脉瘤直接夹闭和血管架桥加动脉瘤孤立的手术效果要好于血栓驱除加载瘤动脉塑形。载瘤动脉临时阻断，载瘤动脉塑形，血管重建及电生理监测是治疗血栓性动脉瘤的重要手段。     

前循环巨大动脉瘤的手术治疗

目的探讨手术治疗脑前循环巨大动脉瘤的方法，设计个体化治疗方案。方法回顾分析2001年1月至2005年3月间手术治疗的38例脑巨大动脉瘤方法和效果。分别采用：直接夹闭瘤颈12例；动脉瘤切除加脑血管重建5例；动脉瘤孤立术4例；颅内外动脉吻合伴或不伴血管内介入治疗14例；包裹1例；载瘤动脉阻断2例。结果术后恢复优良32例，重度病残4例，死亡2例。结论术前应充分评价脑血流动力学和侧支循环，个性化设计治疗方案，采用不同手术术式可取得良好预后；同时颅内外血管吻合术可有效改善颅内供血，确保动脉瘤的后续治疗；手术和血管内介入治疗的结合是今后巨大型动脉瘤治疗的一个方向。     

颅内后循环动脉瘤的临床特征及显微外科治疗

目的 探讨颅内后循环动脉瘤的临床特征、显微外科治疗的方法及其效果.方法 对2000年1月至2008年10月手术治疗的10例颅内后循环动脉瘤的临床资料进行回顾分析.结果 动脉瘤位于基底动脉分叉部4例,大脑后动脉P1-P2交界处2例,小脑后下动脉3例,小脑前下动脉1例.以蛛网膜下腔出血为临床表现者8例,以脑神经麻痹等占位效应为表现者2例;8例行单纯动脉瘤夹闭术,2例行动脉瘤夹闭及残颈包裹术.术后随访6个月至8年,恢复良好6例,中度伤残2例,重度残疾1例,死亡1例.结论 后循环动脉瘤手术较为困难,应选择合适的入路,充分显露动脉瘤和载瘤动脉,术中尽可能保护脑干、脑干穿支动脉及脑神经,以减少手术后致死致残率.