Blood blister-like aneurysms at nonbranching sites of the internal carotid artery
Blood blister-like aneurysms at nonbranching sites of the internal carotid artery
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DOI：
10.3171/jns.2006.105.3.400
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发表时间：
2006-09-01
影响因子：
4.1
通讯作者：
Cho, Ki Hong
中科院分区：
文献类型：
--
作者：
Sim, Sook Young;Shin, Yong Sam;Cho, Ki Hong
对象。发生于颈内动脉（ICA）非分支部位的血泡样动脉瘤（BBAs）的临床特征与囊状动脉瘤不同。在本研究中，作者试图描述尚未明确建立的BBAs的最佳治疗方法。2001年3月至2005年6月期间在作者所在机构就诊的483例动脉瘤性蛛网膜下腔出血患者中，有10例术中在ICA的非分支部位证实有BBAs。10例患者均为女性，年龄在37 ~ 64岁之间（平均年龄49.3岁）；其中5人有高血压病史。7例脑梗死灶位于ICA右侧。所有患者均获得成功治疗；有6例进行了剪裁，3例进行了剪裁与包裹相结合，1例进行了夹住。这些方法与其他各种手术技术结合使用，如通过引流脑脊液进行脑放松、前斜突切除术、暴露颈ICA、温和的枕下夹层（对于粘附在额叶的动脉瘤）、在夹闭前完全捕获ICA以及保护大脑。2例在硬脑膜闭合结束时出现夹片滑移；动脉瘤被完全闭塞使用多个夹联合ICA狭窄在其中一个病例和ICA捕获良好侧支血流在另一个病例。8例患者获得了良好的临床结果，而2例患者因大面积血管痉挛而致残。作者回顾性地回顾了所有病例的放射学和外科资料，以确定哪种治疗方法产生了良好的结果。位于ICA非分支部位的血泡样动脉瘤很难治疗。术前意识和仔细考虑这些病变在手术中可以防止不良的临床结果。
Object. The clinical features of blood blister-like aneurysms (BBAs) that arise at nonbranching sites of the internal carotid artery (ICA) differ from those of saccular aneurysms. In this study, the authors attempt to describe optimal treatments for BBAs, which have yet to be clearly established.Methods. Ten of 483 patients with aneurysmal subarachnoid hemorrhage who had been seen at the authors' institution between March 2001 and June 2005 had intraoperatively confirmed BBAs at nonbranching sites of the ICA. All ten patients were women between the ages of 37 and 64 years (mean age 49.3 years); five had a history of hypertension. The BBAs were localized to the right side of the ICA in seven cases. All patients were successfully treated; clipping was undertaken in six, clipping combined with wrapping in three, and trapping in one. These methods were used in conjunction with various other surgical techniques such as brain relaxation by draining cerebrospinal fluid, anterior clinoidectomy, exposing the cervical ICA, gentle subpial dissection (for aneurysms that adhered to the frontal lobe), complete trapping of the ICA before clipping, and protecting the brain. Clip slippage occurred at the end of dural closing in two cases; the aneurysm was completely obliterated using multiple clips combined with ICA stenosis in one of these cases and ICA trapping with good collateral flow in the other. An excellent clinical outcome was achieved in eight patients, whereas two patients were disabled from massive vasospasm. The authors retrospectively reviewed radiological and surgical data in all cases to determine which treatment methods produced a favorable outcome.Conclusions. Blood blister-like aneurysms located at nonbranching sites of the ICA are difficult to treat. Preoperative awareness and careful consideration of these lesions during surgery can prevent poor clinical outcomes.