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。

Surgical treatment of the anterior circulation giant aneurysms

Objective To discuss the surgical treatment of the anterior circulation giant aneurysms, and to design the individualized treatment options. Methods Clinical data, surgical methods and outcomes were analyzed in 38 giant aneurysms treated from 2001 to 2005. Four patient had the anterior communicating artery aneurysms. Ten had the middle cerebral artery aneurysms. 24 had the internal carotid artery aneurysms. Direct clipping of aneurysmal neck were achieved in 12 cases, aneurysm excision combined with vessels reconstruction in 5 cases, trapping in 4 cases. 14 cases need EC/IC bypass combined with the endovascular occlusion of parent artery. Radial artery was selected as graft for bypass. One case had the aneurysm wrapping. And other 2 cases were selected for the parent artery occlusion. Results Postoperative follow-up demonstrated excellent neurological outcomes in 32 cases. However 4 cases had additional neurological deficits after surgery. Two patients were dead postoperatively. Conclusions Individualization surgical planning is necessary according to the contralateral circulation, location of aneurysms and relationship with the adjacent structure. EC/IC bypass followed by parent vessel occlusion is a safe and effective method of treating giant aneurysm of the anterior circulation. Combined surgical and endovascular treatment might be the future direction for the treatment of giant aneurysms.