[1]徐锋,林通,徐强,等.床突旁动脉瘤的手术夹闭治疗[J].临床神经外科杂志,2018,15(01):1-11.[doi:10.3969/j.issn.1672-7770.2018.01.001]
 XU Feng,LIN Tong,XU Qiang,et al.Surgical clipping of paraclinoid carotid aneurysms[J].Journal of Clinical Neurosurgery,2018,15(01):1-11.[doi:10.3969/j.issn.1672-7770.2018.01.001]
点击复制

床突旁动脉瘤的手术夹闭治疗()
分享到:

《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
15
期数:
2018年01期
页码:
1-11
栏目:
动脉瘤专题
出版日期:
2018-02-15

文章信息/Info

Title:
Surgical clipping of paraclinoid carotid aneurysms
作者:
徐锋林通徐强黄磊陈功徐斌顾宇翔冷冰
200040上海,复旦大学附属华山医院神经外科(徐锋,林通,陈功,徐斌,顾宇翔,冷冰),放射科(徐强,黄磊)
Author(s):
XU FengLIN TongXU Qianget al.
Department of Neurosurgery,Huashan Hospital,Shanghai Medical College,Fudan University,Shanghai 200040,China
关键词:
床突旁动脉瘤 眼动脉 显微外科手术
Keywords:
paraclinoid aneurysmsophthalmic arterymicrosurgery
分类号:
R743.9
DOI:
10.3969/j.issn.1672-7770.2018.01.001
文献标志码:
A
摘要:
目的 探讨床突旁动脉瘤的手术夹闭治疗方法。 方法 回顾性分析2017年2~10月经直接手术夹闭的11例床突旁动脉瘤患者的临床资料。其中动脉瘤改良Barami分型Ⅰa型2个,Ⅰb型3个,Ⅱ型3个,Ⅲa型2个,Ⅲb型1个。5例患者在复合手术室应用球囊辅助手术夹闭治疗。根据格拉斯哥预后量表(Glasgow outcome scale,GOS)评分评定临床疗效。 结果 本组患者的11个动脉瘤均术中磨除前床突后,成功夹闭动脉瘤;其中5个动脉瘤行直接夹闭,6个动脉瘤行塑形夹闭。1例患者应用Hyperform球囊临时阻断;4例患者应用Merci双腔球囊导引导管逆行抽吸颈内动脉;其中2例患者抽吸成功,瘤体明显塌陷,2例患者仅瘤壁张力减低。术后即刻DSA或CTA检查示,10个动脉瘤完全闭塞,仅1个动脉瘤瘤颈少许残留。患者术后出现视力下降1例,动眼神经麻痹1例;所有患者均无言语或肢体功能障碍发生。出院时11例患者均预后良好(GOS评分4~5分)。 结论 床突旁动脉瘤的手术夹闭治疗方法取决于动脉瘤的分型和瘤体大小。改良Barami分型Ⅰ型动脉瘤常采用平行于载瘤动脉直接夹闭,Ⅱ、Ⅲ型动脉瘤则使用跨血管夹塑形夹闭。采用复合手术室球囊辅助逆行抽吸技术,有利于床突旁大型或巨大动脉瘤的手术夹闭。
Abstract:
Objective To explore the clipping strategy of paraclinoid carotid aneurysms. Methods The clinical data of 11 patients with paraclinoid aneurysms who underwent aneurysm clipping in our department from February 2017 to October 2017 were analyzed retrospectively.According to modified Barami classification,2 aneurysms were type Ⅰa,3 type Ⅰb,3 type Ⅱ,3 type Ⅲa and 1 was type Ⅲb.5 aneurysms were clipped with balloon-assisted retrograde suction decompression in hybrid operation room.Clinical outcome was evaluated by Glasgow outcome scale (GOS). Results All patients received the removal of the anterior clinoid process.5 aneurysms were clipped,and 6 aneurysms were treated with clip reconstruction.Among 4 patients received a double-lumen Merci guiding balloon and retrograde suction decompression,only 2 aneurysms were deflated,whereas the other 2 aneurysms did not collapse.Intraoperative angiography or postoperative CT angiography showed 10 aneurysms were successfully obliterated,and only 1 aneurysm was residue.One patient developed decreased vision,1 patient had oculomotor paralysis.No aphasia or any limb paralysis occurred in all patients.Before discharge,all patients had good prognosis (GOS 4-5). Conclusions Clipping strategy of paraclinoid carotid aneurysms depends on classification and aneurysm size.Straight clips were used in type I,whereas fenestrated clips were used frequently in type II and III.Balloon-assisted retrograde suction decompression in hybrid operating room seems to facilitate clipping of large and giant paraclinoid aneurysms.
更新日期/Last Update: 1900-01-01