颅内巨大动脉瘤的处理

目的 对我院1980年以来治疗的33例颅内巨大动脉瘤作一回顾性分析。方法 动脉瘤瘤颈夹闭术13例；动脉瘤孤立或孤立后切除11例，动脉瘤切除或孤立后截瘤动脉重建3例；颈部颈内动脉结扎2例；动脉瘤包裹2例；动脉瘤近侧ICA血管内闭塞2例。结果 术后早期恢复良好24例（24／33）中、重残6例（6／33），死亡3例（3／33）。结论 为消除巨大动脉瘤的占位效应和出血的潜在性，对颅内巨大动脉瘤提倡积极的直接手术治疗。直接夹闭动脉瘤颈并保留截瘤动脉通畅是首选治疗，对必需行动脉瘤孤立且交叉循环不良的病例，应尽保能重建截瘤动脉。

Treatment for the Giant Intracranial Aneurysms

Objective To introduce the experience of treatment of the 33 patients with giant intracranial aneurysms. Methods Direct clipping of the aneurysms was accomplished in 13 cases, aneurysms trapping or removal after trapping in 11 cases, aneurysms excision or trapping followed by parent artery anastomosis in 3 cases, aneurysms wrapping in 2, ligation of the carotid arteries in the necks in 2, and endovascular occlusion of ICA proximal to the aneurysms in 2 cases. Results Early postoperative neurological function was evaluated using Glasgow Outcome Scale. The 24 patients had an excellent or good outcome, 5 moderate to severe disability. The 2 patients died of postoperative aneurysmal bleeding and 1 died of the traumatic intracranial hematoma. Conclusion Direct clipping of the aneurysms is the preferrable method for treatment of the giant intracranial aneurysms, unclippable aneurysms usually require alternative methods for their treatment and it may compromise the parent arteries and may require revascularization to restore sufficient cerebral blood flow.