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。

Surgical management of thrombotic intracranial aneurysms

Objective To study the classification, surgical indications and surgical strategy of thrombotic intracranial aneurysms. Methods Forty-eight patients with thrombotic aneurysms were treated by surgery. The aneurysms included 13 concentric, 27 eccentric, 2 lobulated, 4 canalized and 2 coiled aneurysms. In terms of sites, there were 2 cavernous, 14 paraclinoid, 13 supraclinoid, 4 anterior cerebral artery, 8 middle cerebral artery and 7 vertebral-basilar artery aneurysms. Aneurysm treatment consisted of direct clipping (n=18), thrombectomy-clip reconstruction (n=21), bypass-occlusion (n=7), other (n=2). Results The postoperative DSA showed that complete angiographic obliteration was achieved and all bypass grafts were patent in 45 cases. Overall, 44 patients were improved, 2 coma, 1 hemiplegia and 1 died. Follow-up period was from 2 months to 4 years, 39 cases reached a Glasgow Outcome Scale score of 4 to 5. Conclusion The classification of the thrombotic intracranial aneurysms is benefit to the preoperative planning. The better results were observed in patients treated with direct clipping and bypass-occlusion than with thrombectomy-clip reconstruction. The temporary arterial occlusion, parent artery reconstruction, bypass and electrophysiological monitoring are necessary to treat the thrombotic intracranial aneurysms