大型和巨大型颈内动脉眼动脉段动脉瘤的显微神经外科手术治疗

Microneurosurgical Management of Large and Giant Internal Carotid Artery Aneurysms of Ophthalmic (C6) Segment

目的探讨显微神经外科手术治疗大型和巨大型颈内动脉眼动脉段动脉瘤的疗效。方法回顾性分析近年经显微神经外科手术治疗的大型和巨大型颈内动脉眼动脉段动脉瘤患者临床资料。结果手术方式包括:开颅动脉瘤直接夹闭术、载瘤动脉塑形夹闭术、载瘤动脉近端闭塞术和动脉瘤包裹术。对所有患者出院时进行GOS评分,恢复良好者25例,中残3例,重残2例,死亡2例。结论大型和巨大型颈内动脉眼动脉段动脉瘤应积极治疗,显微神经外科手术可显著提高治愈率和减少并发症。完善术前检查、充分术前准备和必要的术中监测是成功治疗的前提,而术中良好微创显露、合理血管阻断、充分减压和妥善夹闭技术是成功治疗的关键。

Aim To explore the microneurosurgical outcomes of large and giant internal carotid artery aneurysms of ophthalmic(C6) segment. Methods The medical records of patients with large and giant C6 aneurysms microneurosurgically treated at our hospitals were analyzed retrospectively. Results Therapeutic modalities contained direct microneurosurgical clipping, clipping with internal carotid artery revascularization, trapping, and wrapping. According to the evaluation of GOS rating, the good or excellent outcome were 25 cases, the middle disabled were 3 cases, the severely disabled were 2 cases, and the death were 2 cases. Conclusion Large and giant C6 aneurysms should be treated positively, and microneurosurgical treatment can notably improve its recovery rate and decrease its complications. Complete preoperative examinations, adequate preoperative preparations and necessary intraoperative monitoring are the premise of successful treatment. Intraoperative minimally invasive exposure, reasonable vessel occlusion, sufficient aneurysmal decompression and proper clipping skills are the key points of successful treatment.