颈内动脉血泡样动脉瘤的显微夹闭术效果评价

目的 探讨颈内动脉床突上段血泡样动脉瘤的临床特征、手术方法及其效果。方法 回顾性分析2012年1月至2016年6月收治的15例颈内动脉突上段血泡样动脉瘤的临床资料，其中13例采取直接夹闭，1例夹闭加周围包裹小片颞肌进行加固，1例多发动脉瘤采取环绕包裹夹闭。结果 2个破裂动脉瘤和1个未破裂动脉瘤术前有生长现象；2个破裂动脉瘤和5个未破裂动脉瘤有子囊形成；9例颈内动脉床突上段有不同程度硬化。1例出院时改良Rankin量表（mRS）评分4分，1年随访mRS评分3分；1例多发未破裂动脉瘤出院mRS评分5分，1年随访无改善；其余13例术后1年mRS评分0分，复查血管造影均未见动脉瘤复发。4例术后发生载瘤动脉狭窄，但均未出现神经功能缺失。结论 破裂和未破裂颈内动脉床突上段血泡样动脉瘤可能经历不同的演变，前者先破裂后生长，后者产生子囊进而破裂。显微夹闭术是一种治疗颈内动脉血泡样动脉瘤简便易行的手段，多数病例可以取得良好效果；但是对载瘤动脉严重硬化的动脉瘤，直接夹闭比较困难和危险，应该选择合适的替代方案。

Curative effects of microsurgical clipping on blister-like aneurysms of internal carotid artery (report of 15 cases)

Objective To assess the curative effects of microsurgical clipping on the blister-like aneurysms (BLAs) of the internal carotid artery (ICA). Methods The clinical data of 15 patients with 16 BLAs of the supraclinoid ICA, who underwent microsurgical clipping under elctrophysiological monitoring from January, 2012 to June, 2016, were analyzed retrospectively, including the clinical characteristics, radiological features, and intraoperative findings. The treatment strategies were discussed. The prognoses in the patients were assessed by the modified Rankin scale (mRS) 1 year after the surgery. Results Morphologically, aneurysm growth before surgery occurred in two ruptured and one unruptured BLAs. A daughter bleb formation was observed on angiographic images in every one of two ruptured and five unruptured BLAs. Varied range of sclerosis on the supraclinoid segment of ICA existed in 9 patients. Sixteen BLAs were successfully occluded in 15 patients. The following-up 1 year after the surgery showed that of 15 patients 13 had favorable outcomes (mRS 0 score) and 2 unfavorable outcomes (mRS 3 and 5 scores respectively). Conclusions It is more likely that ruptured and unruptured BLAs have different evolving processes. Microsurgical clipping is relatively a concise and feasible method to treat ICA BLAs, and can bring good outcomes to most patients with ICA BLAs. However, it is extremely difficult and dangerous to adopt direct clipping, and an appropriate alternative solution should be determined in the ICA BLAs patients with severely atherosclerotic parent artery wall.