手术所见特殊形态的颅内动脉瘤

Some intracranial aneurysms with special morphology found in operations

目的:探讨手术所发现的特殊形态、破口变异及瘤壁异常颅内动脉瘤的某些特征。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,寻找这些动脉瘤的特征。结果:发现破口较大或"潜在性"破口6例,其中2例先行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6天再次破裂出血,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手术需谨慎,术前准备应充分,术前造影具有一定特征。

Objective： Through surgical operations to study some intracrenial aneurysms with special morphology, variant site of rupture and abnormal aneurysms wail.Method： Retrospectively reviewed 174 patients with intracranial aneurysms which were clipped through craniotomy from January 2001 to January 2007. Fifteen cases （8.6 % ） were found with special morphology. Observation was made about their appearance, size end site of rupture, thickness of aneurysms wall, and relation with parent artery as well as significant branches. 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 rehleediug in 6 days after endovascular emholization to be verifed coils leaked out from the thin aneurysrns wall, 1 ease formed by enlargement of bilateral anterior communicating - artery, and 1 ease with posterior communicating- artery aneurysm were not able to be dipped through craniotomy as thin aneurysms wall and neck and parent artery. Conclusion： Of intraeranial aneurysms with special morphology, preoperative angiography is of some imaging feature. The fully preoperative preparation for these patients is essential for the safety and success of operation.