Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms
Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms
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DOI：
10.3171/jns.1996.84.2.0185
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发表时间：
1996-02-01
影响因子：
4.1
通讯作者：
Spetzler, RF
中科院分区：
文献类型：
--
作者：
Anson, JA;Lawton, MT;Spetzler, RF
扩张动脉瘤和梭形动脉瘤是脑动脉瘤的一小部分，通常是最难治疗的动脉瘤之一。连续40例患者，其中41例这两种类型的动脉瘤，包括他们的临床特点和手术治疗。所有动脉瘤的共同之处是病变累及一段不同流入和流出部位的血管(非囊状)。然而，指趾扩张性动脉瘤的症状和手术治疗因其在前循环或后循环中的位置不同而明显不同。前循环动脉瘤累及岩部颈内动脉1例，枕骨上颈内动脉3例，大脑中动脉13例，大脑前动脉4例。后循环动脉瘤累及基底动脉13例，椎动脉6例，小脑后下动脉1例。手术方式包括直接夹闭、搭桥术、近端闭塞、切除再吻合、移位、动脉瘤修补加血栓切除和包裹术。在患者系列中没有手术死亡，许多患者的治疗是有效的。总体而言，78%的患者晚期随访结果良好(格拉斯哥结果量表评分1-2)。前循环动脉瘤的预后优于后循环动脉瘤，优良率分别为90%和65%。十二指肠扩张型和巨型蛇形动脉瘤可由较小的梭形动脉瘤发展而来，代表同一病理实体的不同谱系。动脉夹层也可能在这些动脉瘤的最初发展中起作用。
Dolichoectatic and fusiform aneurysms represent a small subset of cerebral aneurysms and are often among the most difficult to treat. A consecutive series of 40 patients with 41 of these two types of aneurysms is presented, including their clinical characteristics and surgical treatments. Common to all aneurysms was the pathological involvement of a length of blood vessel with separate inflow and outflow sites (nonsaccular). However, dolichoectatic aneurysms have markedly different symptoms and surgical treatments depending on their location in either the anterior or posterior circulation. Anterior circulation aneurysms involved the petrous internal carotid artery (ICA) in one, the supraclinoid ICA in three, the middle cerebral artery in 13, and the anterior cerebral artery in four patients. Posterior circulation aneurysms involved the basilar artery in 13, the vertebral artery in six, and the posterior inferior cerebellar artery in one patient. Various surgical procedures were performed, including direct clipping, trapping with bypass, proximal occlusion, resection with reanastomosis, transposition, aneurysmorrhaphy with thrombectomy, and wrapping. There was no surgical mortality in the patient series, and treatment was effective in many patients. Overall, outcome at late follow up was good (Glasgow Outcome Scale scores 1-2) in 78% of patients. Patients with anterior circulation aneurysms had better outcomes than patients with posterior circulation aneurysms, with good outcomes in 90% and 65% of the cases, respectively. Dolichoectatic and giant serpentine aneurysms may develop from smaller fusiform aneurysms and represent a spectrum of the same pathological entity. Arterial dissection may also play a role in the initial development of these aneurysms.