眼动脉段颈内动脉巨大动脉瘤的手术治疗(一种新的治疗方法)

目的探讨颅内外颈内动脉临时阻断，动脉瘤直接穿刺夹闭眼动脉段颈内动脉巨大动脉瘤的可行性。方法经头颅CT或MRI扫描与DSA检查确诊为眼动脉段颈内动脉巨大动脉瘤后，病灶侧做压颈测验，侧支循环代偿率达70％以上时确定手术日期。手术时先暴露颅外颈内动脉（extracranial internal carotid artery, EICA），置粗丝线做临时阻断时用，后行额颞开颅术，暴露视神经颅内远端颈内动脉（intracranial distal internal carotid artery, IDICA）、后交通动脉（post-communicating artery，PCA），最后分离和聚露动脉瘤及其周围结构。临时阻断EICA、IDICA和PCA，穿刺针直接穿刺动脉瘤减压，待动脉瘤塌陷后夹闭动脉瘤颈。动脉瘤夹闭前后用TCD分别监测IDICA、PCA以及动脉瘤体的血流，变化。结果术后病人神志清楚，未出现新的神经系统征象，经DSA检查，动脉瘤消失，颈内动脉循环良好。结论颅内外颈内动脉临时阻断，动脉瘤抽吸夹闭眼动脉段颈内动脉巨大动脉瘤是一种简单、安全、疗效确切的方法。术中应用TCD监测，对预测预后有益。

Surgical treatment of giant carotid-ophthalmic aneurysms ( a new treatment method)

Objective To investigate the possibility of the temporary occlusion of extracranial internal carotid artery(EICA) , intracranial distal internal carotid artery (IDICA) and post-communicating artery(PCA) for surgical treatment of giant carotid-ophthalmic aneurysm. Methods Matass test was given on the carotid artery of the aneurysm side after giant carotid-ophthalmic aneurysm was diagnosed by head CT or MRI and DSA. Only when over 70% of compensative rate of compensative circulation was confirmed, surgical date was defined. First the EICA was exposed, a pterional approach was performed. IDICA, optic nerve, post-communicating artery and aneurysm and its surrounding structures were exposed in proper order. EICA was occluded then IDICA, post-communicating arteries were clipped with temporary clips. After decompression of the aneurysm with a puncture needle, the aneurysm was clipped after the aneurysm collapse. TCD was used to monitor the blood flow of IDICA, post-communicating artery, and aneurysm before and after aneurysm clip. Results Patients was clear in consciousness, a new symptom and sign of nervous system were not seen. Carotid-ophthalmic aneurysms disappear by DSA, blood flow of internal carotid artery was normal. Conclusions A method of temporary occlusion of ECA and IDCA and post-communicating artery, direct puncture decompression of aneurysm and clip aneurysm is the method of convenient, safe ,and reliable result. TCD is of great benefit in during operation for appraising prognosis.