Monitored gradual occlusion of the internal carotid artery followed by ligation for giant internal carotid artery aneurysms
Monitored gradual occlusion of the internal carotid artery followed by ligation for giant internal carotid artery aneurysms
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DOI：
10.4103/0028-3886.96396
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发表时间：
2012-03-01
期刊：
影响因子：
2.7
通讯作者：
Mahapatra, A. K.
中科院分区：
文献类型：
--
作者：
Rathore, Yashpal Singh;Chandra, P. S.;Mahapatra, A. K.
目的：探讨逐步监测颈内动脉(ICA)闭塞，然后结扎巨大动脉瘤作为球囊试验闭塞ICA后永久性结扎ICA的方法。材料和方法：回顾分析2001年1月至2010年12月间行颈动脉结扎术的27例颈内动脉巨大复杂动脉瘤患者的临床资料。临床表现包括头痛、视力丧失和复视。海绵状动脉瘤19例，床上动脉瘤5例，眼动脉瘤1例，岩段动脉瘤1例，颈段动脉瘤1例。所有患者均表现出良好的交叉循环。采用Selverstone钳在重症监护室密切观察下逐渐阻断颈内动脉72h以上。结果：6例患者术后出现偏瘫。1名患者在两到三周后有所改善，其余5名患者有残存的偏瘫。1例患者发生恶性大脑中动脉梗死，需行开颅减压术。本组病例无死亡病例。结论：对于手术难以触及和复杂的动脉瘤，逐步监测闭塞和颈内动脉结扎术可能是一种简单、安全的替代方法，尤其是对于经验有限的外科医生。交叉循环检查是颈动脉结扎的绝对必要条件。
Objective: To demonstrate a technique of gradual monitored occlusion of the internal carotid artery (ICA) followed by ligation for giant aneurysms as an option for balloon test occlusion followed by permanent ligation of ICA. Materials and Methods: Authors retrospectively analyzed 27 patients with giant and complex ICA aneurysms who underwent carotid artery ligation between January 2001 and December 2010. Clinical presentation included headache, vision loss and diplopia. There were 19 patients with cavernous aneurysm, 5 supraclinoid, 1 ophthalmic, 1 petrous segment and 1 cervical segment aneurysm located extracranially. All demonstrated good cross-circulation. Selverstone clamp was used for gradual occlusion of the ICA over 72 h under closed observation in the intensive care unit. Results: Six patients developed hemiparesis in the postoperative period. Improvement occurred in one patient over two to three weeks while the remaining five patients had residual hemiparesis. One patient developed malignant MCA infarct for which decompressive craniectomy had to be done. There was no mortality in the present series. Conclusions: Gradual monitored occlusion and ICA ligation may be a simple, safe alternative procedure to clipping in surgically inaccessible and complex aneurysms, especially for surgeons with limited experience. Cross circulation study is an absolute requisite for carotid ligation.