动脉瘤体切除和载瘤血管重建治疗巨大动脉瘤

Aneurysmal sac excision and parent vessel reconstruction in treatment for giant aneurysms

目的：介绍颅内巨大动脉瘤体切除和载瘤血管重建手术方法。方法：（１）切除动脉瘤壁，重建载瘤动脉。（２）应用窗式成角动脉瘤夹重建载瘤动脉。（３）颈内动脉慢性结扎，动脉瘤孤立术。结果：３２例颅内巨大动脉瘤位于：颈内动脉１８例（包括７例海绵窦段），中动脉９例，前交通动脉３例，大脑后动脉２例。术后优良者２６例（８１％），本组无一例死亡，术后病残率６例（１９％）。随访６～２４月，全部病例恢复正常工作学习。结论：动脉瘤切除和载瘤动脉重建是手术治疗巨大动脉瘤有效的外科手段。

Objective: To introduce the surgical techniques of aneurysmal sac excision and parent vessel reconstruction in treatment for giant aneurysms. Methods:(1)excision of aneurysmal sac and microsuturing for vascular reconstruction;(2)angle fenestrated clips for reconstruction of the parent artery;(3)crutchfield clamp for gradual occlusion of the internal carotid artery and aneurysm trapping. Results:Of 32 patients with intracranial giant aneurysms (φ>25mm),18 were giant internal carotid aneurysms (including 7 cavernous aneurysms),9 middle cerebral artery aneurysms,3 anterior cerebral/communicating artery aneurysms and 2 giant posterior cerebral aneurysms. Excellent or good postoperative results were achieved in 26 patients(81%). The operative mortality rate was 0% and morbidity rate was 19%. All of the 32 patients had recovered in 6～24 months' follow up. Conclusion:The surgical techniques of aneurysmal sac excision and parent vessel reconstruction are effective in treatment for giant aneurysm.