鞍区动脉瘤临床诊治

Analysis of the diagnosis and treatment of aneurysm in the sellar region

目的:探讨鞍区动脉瘤的临床诊断与治疗策略。方法:回顾性分析20例鞍区动脉瘤患者临床资料,术前对疑为鞍区动脉瘤者行CTA、MRA或DSA检查明确诊断,其中15例采用显微外科手术治疗,3例采取介入手术治疗,2例保守治疗并随访观察。结果:20例鞍区动脉瘤中19例术前诊断明确,1例误诊。15例手术治疗均获成功,其中12例显微外科手术成功夹闭动脉瘤,同时保留了载瘤动脉的通畅,1例行载瘤动脉近端阻断瘤栓清除术,1例行动脉瘤包裹术,1例行患侧颈动脉结扎治疗术,3例介入手术治疗成功。2例保守治疗分别随访2年和4年未破裂。结论:鞍区动脉瘤诊断困难,易与鞍区肿瘤混淆,对可疑者应及时行CTA、MRA或DSA检查,确诊后选择恰当治疗方案,有明确占位效应的鞍区动脉瘤选择显微外科手术治疗,来源于颈内动脉海绵窦段的鞍区动脉瘤选择介入治疗,对无症状的海绵窦段动脉瘤可随访观察。

Objective To explore the diagnosis and treatment of sellar region aneurysms. Methods The clinical data were retrospectively analyzed in 20 cases of sellar region aneurysm. Pre-operative suspected sellar region aneurysms patients underwent CTA, MRA or DSA inspection for clear diagnosis. In all cases, 15 received microsurgery, 3 received interventional treatment, and 2 were treated conservatively and followed up. Results In all patients, 19 cases were diagnosed accurately before operative and 1 was misdiagnosed. Of all, 15 patients got success surgery, 12 aneurysm clipping patients preserved the parent artery normal, 1 of the proximal artery blocking and bolt was removed, 1 aneurysm was wrapped, and 3 accepted interventional treatment. Two aneurysms were still un-ruptured in 2 and 4 years respectively. Conclusion Sellar region aneurysms＇ diagnosis is difficult. It＇s easy to be confused with the sellar region tumors. The patients should receive CTA, MRA or DSA inspection, and receive an appropriate treatment. The patients with sellar aneurysm occupy should receive microsurgery, while those with carotid-cavernous aneurysm should receive interventional treatment. However, conservative treatment plus follow-up is an option for carotid- cavernous aneurysm without clinical symptoms.