瘤颈处理困难的床突上段动脉瘤三例报告

Rare complex aneurysm of special type in the superior segment of clinoid process of internal carotid artery

目的探讨罕见颈内动脉床突上段特殊类型复杂动脉瘤某些特征，临床特点及治疗方法。方法通过3例十分罕见颈内动脉床突上段动脉瘤的治疗经过，总结手术中所遇见的瘤颈撕裂，载瘤动脉壁薄、撕裂，血栓形成，无法夹闭等特殊情况，并且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。结果发现这种特殊动脉瘤，载瘤动脉局部不规则钙化、增粗畸形，甚至载瘤动脉壁菲薄；动脉瘤发生部位不规则，瘤颈及瘤体壁菲薄，显微镜下见瘤体壁薄呈紫红色，手术时轻微分离瘤颈或夹闭时容易撕裂，或载瘤动脉壁撕裂，无法修补止血；2例术中由于载瘤动脉钙化而坚硬，其近端不能予以临时阻断控制；瘤颈内有部分血栓侵犯，导致瘤夹闭合不全，调整瘤夹易撕裂瘤颈。结论手术需谨慎，术中有可能无法夹闭或载瘤动脉壁破裂，术前造影具有明显特征，手术方法以颅内外血管吻合＋孤立为妥。

Objective To discuss the features, clinical characteristics and therapies of rare aneurysm of special type in the superior segment of clinoid process of internal carotid artery. Method From clinical courses of treatment of 3 patients with extremely rare aneurysms in the superior segment of clinoid process of internal cardotid artery, we summarized special clinical characteristics including torn aneurysm neck,thin or torn tumor - loading artery wall, thrombosis, and clipping failure,etc. , encountered during the surgery,and compared them with pre - surgical imaging data, to investigate features of this type of aneurysms. Results Of such special neurysms, it was found that the tumor - loading artery was irregularly calcified, thickened and deformed, or even the tumor - loading artery wall was extremely thin. Such neurysms occurred in irregular sites, with quite thin tumor neck and tumor body wall. Under a microscope, the tumor body wall was carmine. It was readily torn in slight isolation or clipping during surgery, or the tumor - loaded artery wall was torn, being difficult to be repaired for hemostasis. In 2 patients, it was hard due to calcified tumor - loading artery, and its proximal end was often unable to be controlled by temporary blockage. Some thrombosis occurred in tumor neck, leading to uncomplete clipping of aneurysm, and the tumor neck was readily torn during adjustment of the tumor clips. Conclusions Caution should be exercised during surgery. Clipping failure or torn tumor - loading artery wall may occur during surgery. The pre- surgical angiography has obvious characteristics, and it is better that the surgical method be extra - and intra - cranial vascular anastomosis plus isolation.