血液回抽吸技术在巨大动脉瘤手术中的应用

目的 探讨床突旁大型或巨大动脉瘤手术中血液回抽吸技术的方法和效果.方法 12例颈内动脉床突旁段大型或巨大动脉瘤均采用翼点入路,颈内动脉临时阻断孤立动脉瘤后用18号套管针在颈部颈内动脉阻断的远端穿刺,将套管针尾部用负压吸引器连接到血液回收装置,在不切开动脉瘤的情况下使动脉瘤塌陷.术中应用脑电图和体感诱发电位监测.结果 8例血液逆向抽吸后动脉瘤明显塌陷,将动脉瘤壁与周围结构剥离后夹闭.4例逆向抽吸后动脉瘤塌陷不明显,其中3例切开动脉瘤去除瘤内血栓后夹闭动脉瘤,1例改做动脉瘤孤立并行大隐静脉移植颈外动脉-大脑中动脉搭桥.8例术后行DSA检查,动脉瘤均夹闭满意.按改良COS评分术后良好为10例,差为1例,死亡l例.结论 血液回抽吸方法能使大部分床突旁大型或巨大动脉瘤塌陷,从而获得安全和满意的夹闭.术中应用电生理监测有助于发现早期的脑缺血和判断动脉瘤夹闭后有无载瘤动脉狭窄或误夹.

Retrograde suction decompression for the management of large or giant paraclinoidal aneurysms

Objective To explore the technique and effect of retrograde suction decompression for the management of large or giant paraclinoidal aneurysms. Method 12 cases of paraclinoidal aneurys msused pterional approach. After temporary trapping, a No. 18 angiocatheter is inserted into the cervical internal carotid artery. This catheter is then connected to a blood reuse unit, which is connected to a wall suction, allowing the aneurysm rapid deflation without the cutting of aneurysm, lntraoperative EEG and SEP monitoring was applied to check the brain function. Results The aneurysms significantly deflated after the retrograde suction and were clipped safely and satisfactorily in 8 cases. The aneurysms didn't deflate in 4cases,out of the 4 cases, the aneurysms were cut and remove the thrombus in the aneurysms and then clipped in 3 cases, another was trapped with bypass of external carotid artery to MCA with great saphenous vein graft. Postoperative angiography was taken in 8 cases, showed that aneurysms was clipped satisfactorily.According to modified GOS, good in 10 cases in the early stage, poor in 1 cases, and 1 died. Conclusions Retrograde suction decompression can make most of paraclinoidal aneurysms deflation, which is helpful for the safe and satisfactory clipping of aneurysms. Intraoperative EEG and SEP monitoring contribute to find early cerebral ischemia and to make sure if the parent artery is narrowed or the normal artery is clipped unexpected.