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.

Surgical management of large and giant intracavernous and paraclinoid aneurysms

Objective To study the characteristics,SUrgical indications,and treatment strategies of large and giant intracavernous and paraclinoid aneurysms.Methods From 1998 to 2006,thirty-six patients with large and giant intracavemous and paraclinoid aneurysms were underwent surgical treatment.The pterional approach was routinely used and the internal cervical carotid Was exposed.Direct clipping,pseudoaneurysm repairing,and trapping with extracranial-intracranial bypass were performed.Intra-operative electroencephalogram(EEG)and somatosensory evoked potentials(SEP)monitoring,microvascular Doppler uhrasonography(MDU)and endoscope were regularly used.Results Thirty-two paraelinoid aneurysms were directly clipped.1 intraeavernous pseudo-aneurysm was repaired.and 3 intracavernous aneurysms were trapped with extraeranial-intracranial revascularization.At discharge,thirty-two(89%)patients had a Glasgow Outcome Scale score of 4 to 5,two patients were severe disability(5.6%)and two were dead(5.6%).Conclusions The intracavernous aneurysms unamenable to endovascular treatment should be treated surgically and surgicat treatment is also the first choice of treatment for paraclinoid aneurysms.