手术所见某些特殊形态的颅内动脉瘤

Intracraniai aneurysms with special morphology found in operations

目的探讨通过手术所发现的特殊形态、破口变异及瘤壁异常的颅内动脉瘤某些特征。方法回顾总结直接开颅夹闭的174例颅内动脉瘤，发现其中15例（8．6％）形态特殊，术中将瘤周围血肿及组织清除干净后仔细观察动脉瘤形状，是否分叶，测量破口大小、位置，瘤壁的厚薄等，并进行局部高倍镜下三维照相，与术前的影像学资料进行对比研究，寻找这些动脉瘤的某些特征。结果发现破口较大或“潜在性”破口6例，其中2例先栓塞导致弹簧圈漏出破口，后经过手术取出治愈；呈分叶状6例；1例栓塞成功后6d再次破裂出血，手术发现瘤壁菲薄致弹簧圈漏出；双侧前交通动脉复合体膨大形成动脉瘤1例；1例后交通动脉瘤开颅后所见载瘤动脉及瘤壁、瘤颈菲薄无法夹闭而孤立载瘤动脉。结论某些特殊形态动脉瘤治疗需谨慎，术前准备应充分，术前造影具有一定特征。

Objective To study some intracranial aneurysms with special morphology, variant site of rupture and abnormal aneurysms wall. Method 174 patients with intracranial aneurysms which were clipped through craniotomy from January 2001 to January 2007 were reviewed retrospectively. Fifteen cases （ 8.6% ） were found with special morphology. Aneurysmal appearance, size and site of rupture, thickness of aneurysm wall, and relation with parent artery as well as significant branches were observed. Under high microscopic magnification, photoes were taken to compare with preoperative imaging data to collect imaging feature of these intracranial aneurysms. Results Of these 15 cases of intracranial aneurysms,6 cases were with giant or potential rupture site（ in 2 cases, coils leaked out from split after endovascular embolization and were healed by dislodgment through craniotomy ） , 6 cases with lobular shape, 1 case with rebleeding in 6 days after endovascular embolization to be verifed coils leaked out from the thin aneurysms wall, 1 case formed by enlargement of bilateral anterior communicating-artery , and 1 case with posterior communicating-artery aneurysm were not able to be clipped through craniotomy as thin aneurysms wall and neck and parent artery. Conclusions Preoperative angiography can reveal some imaging feature for the intracranial aneurysms with special morphology. Preoperative preparation is necessary.