前循环巨大动脉瘤的手术治疗

Surgical treatment for the giant aneurysms of anterior circulation

目的 对 1985年以来经手术治疗的 18例前循环巨大动脉瘤作一回顾性分析。方法 行动脉瘤瘤颈夹闭术 11例 ,动脉瘤孤立或孤立后切除 4例 ,动脉瘤切除或孤立后载瘤动脉重建 2例 ,动脉瘤包裹 1例。结果 动脉瘤瘤颈夹闭术的 11例病人中 ,除 1例术前Hunt Hess分级IV级的病人术后重残外 ,均恢复良好。动脉瘤孤立或孤立后切除的 4例病人中 ,1例后交通动脉瘤 (PCoA)病人虽术前血管造影证实侧支循环充分 ,但术后出现暂时性对侧轻偏瘫。另 1例大脑中动脉 (MCA)动脉瘤病人术后第 6天因术野血肿再次进行手术 ,出院时能独立行走。行动脉瘤切除或孤立后载瘤动脉重建的 2例病人恢复良好。动脉瘤包裹术的 1例病人术后因再出血死亡。结论 为消除巨大动脉瘤的压迫症状和潜在的出血危险 ,对前循环巨大动脉瘤主张积极的手术治疗。动脉瘤瘤颈夹闭并保留载瘤动脉通畅是首选治疗 ,对必需行动脉瘤孤立且交叉循环不良的病例 。

Objective To analyze the results of our 18 patients with the giant aneurysms of the anterior circulation retrospectively. Methods All patients had been surgically treated, of which, direct clipping of the aneurysms was accomplished in 11 patients, aneurysms trapping or removal after trapping in 4, aneurysms excision or trapping with parent artery anastomosis in 2, and aneurysms wrapping in 1. Results Early postoperative neurological function was evaluated according to Glasgow Outcome Scale. All 11 patients with direct clipping of the aneurysms and 2 patients performed aneurysms excision or trapping with parent artery anastomosis gained good recovery except for one who had preoperative IV grade according to Hunt and Hess grades after SAH and underwent severe disability postoperatively. In 4 patients with aneurysms trapping or excision after trapping, 1 patient experienced temporary contralateral hemiparesis, and another patient in this group underwent the hemorrhage in the operative field and recovered smoothly after a second operation for eliminating hematoma. 1 patient with aneurysmre wrapping died due to postoperative aneurysm rebleeding. Conclusions Direct clipping of the aneurysms is the preferred method for the giant intracranial aneurysms, Unclippable aneurysms require alternative methods that might compromise parent arteries and may require revascularization to restore sufficient cerebral blood flow.