颈内动脉床突上段动脉瘤的手术及疗效分析

目的 对颈内动脉床突上段动脉瘤的临床手术病例进行分析,总结该部位动脉瘤显微神经外科手术的经验和教训,以进一步改善疗效.方法 回顾性分析2004年5月至2009年3月手术治疗24例颈内动脉床突上段动脉瘤患者的临床资料,其中大型、巨大型动脉瘤18例,中型、小型动脉瘤6例.手术方式包括动脉瘤直接夹闭术、动脉瘤部分切除塑形术、动脉瘤孤立术或切除塑形+颅内外动脉搭桥术等.结果 术后无神经功能障碍8例.不同程度肌力下降10例,5例出院时恢复到4级,伴发失语3例,视力严重下降5例,眼球活动障碍4例.深昏迷(死亡)2例.二次手术3例.总手术优良率66.7%(16/24),病死率8.3%(2/24).结论 颈内动脉床突上段动脉瘤手术难度较大,眼动脉段动脉瘤不易显露动脉瘤颈,而某些大型、巨大型动脉瘤手术更加困难,需要临时阻断载瘤动脉,切除部分动脉瘤才能夹闭.手术仍以夹闭术疗效为好.对于伴有瘤内血栓的病例,应先行颅内外动脉搭桥术,但可能由此带来一些严重并发症.

Microsurgical procedures and the results of supraclinoid internal carotid aneurysms

Objective To analyze the features of supraclinoid internal carotid aneurysms. The experience and mistakes in the microsurgery of supraclinoid internal carotid aneurysms were summarized to improve the results. Methods The data of 24 cases of supraclinoid internal carotid aneurysms that were operated from May 2004 to March 2009 were reviewed. There were 6 cases of small or middle aneurysms, 18 cases of large or giant aneurysms. The operative methods included direct clipping, partial excision of aneurysm with reconstruction of the parent artery, aneurysm trapping with extracerebral/intracerebral (EC-IC) bypass, etc. Results Among the 24 cases, 8 cases had good results. Ten cases occurred hemiplegja post operation immediately, with 5 cases recovered to grade IV ,3 cases had aphasia,5 cases with vision acuity fall,4 cases had abnormal eyeball movement,2 cases had continued coma and died finally. Second operations were performed in 3 cases. The total operation rate of well results was 66.7% (16/24). Mortality rate was 8.3% (2/24). Conclusions The operative technique of the supraclinoid internal carotid aneurysms is difficult because of the location and the large size of the aneurysms. The temporary obstruction' of the parent artery is often needed, so the aneurysm can be partially resected and clipped. The results of clipping of large or giant aneurysms are better than the other methods. But in large or giant aneurysms that had thrombus, the EC-IC bypass is needed to prevent large infarction. The bypass procedure may induce some severe complications that result in some poor outcome.