存在瘤内血栓的颅内大型动脉瘤的手术治疗

Surgical Treatment of Large Intracranial Aneurysms with Intraaneurysmal Thrombus

目的探讨伴有瘤内血栓的颅内大型或巨大型动脉瘤的诊断和手术治疗。方法本组瘤内有陈旧性血栓的颅内大型动脉瘤62例,其中行动脉瘤瘤颈夹闭或塑型夹闭47例,动脉瘤孤立术13例,动脉瘤部分切除后缝合瘤壁重建载瘤动脉1例,另1例双侧椎动脉汇合处巨大梭形动脉瘤在深低温、停循环技术辅助下行载瘤动脉重建手术。结果根据GOS评分,病人恢复良好51例(82.3%),中残4例(6.5%),重残2例(3.2%),死亡5例(8.1%)。中、重残病例随访一年以上,中残的4例中3例恢复术前生活能力;重残的2例中,1例因大面积脑梗死、偏瘫仅有部分恢复,另1例深低温、停循环辅助手术病例,手术后2d内意识清楚,但术后13个月因肝功能衰竭死亡。结论颅内血栓性大型或巨大型动脉瘤手术处理困难,致残率及死亡率高于同类型无血栓的颅内动脉瘤。载瘤动脉暂时性阻断、动脉瘤切开血栓清除均有助于瘤颈夹闭。

Objective To explore the diagnosis and surgical treatment of large and giant intracranial aneurysms with intraaneurymal thrombus. Methods Of 62 cases of large and giant intracranial aneurysms with intraaneurysmal thrombus. 47 were treated by clipping aneurysmal necks, 13 by trapping and wrapping aneurysms, 1 by resecting the part aneurysmal sac and reconstructing the parent artery, and 1, which is giant vertebrobasilar fusiform aneurysm, by reconstructing the parent artery reconstruction under deep hypothermic arrest of circulation. Results According to GOS, of 62 patients, 51 （82.3%） were recovered well, 4 （6.5%） moderately disabled, 2 （3.2%） were severely disabled and 5 died （8.1%）. The patients with moderate and severe disability were followed up for more than one year. In 4 patients with moderate disability, 3 returned to the normal work. Of 2 patients with severe disability, 1 was partially recovered from his hemiplegia caused by massive cerebral infaction and 1 died of hepatic failure 13 months after the operation. Conclusions The surgery for the large and giant aneurysms with thrombus is more difficult than those for the aneurysms without thrombus. The disabled rate and mortality in the patients suffering from the aneurisms with thrombus are higher than those in the patients with aneurysms without thrombus. The temporary occlusion of the parent artery and elimination of intraaneurysmal thrombus are helpful to clipping the aneurysmal neck.