床突旁动脉瘤的手术策略及疗效

Surgical strategies and efficacy of paraclinoid aneurysms

目的探讨床突旁动脉瘤的手术策略及疗效。方法回顾分析我院2010年1月-2014年5月46例行手术治疗床突旁动脉瘤患者的临床资料,其中男性8例,女性38例,年龄22-72岁,平均50.15岁。17例动脉瘤破裂,9例罹患多发动脉瘤。眼动脉瘤22个、梭性动脉瘤10个、垂体上动脉瘤8个、窝动脉瘤3个、蛇形动脉瘤1个、假性动脉瘤5个。20个动脉瘤≤5 mm,15个5~15mm,14个≥15 mm。手术策略包括直接夹闭、夹闭塑形、颅内外血管架桥、颈动脉结扎和动脉瘤包裹。根据格拉斯哥评分（Glasgow outcome scale,GOS）评估临床疗效。结果 19个动脉瘤直接夹闭,21个夹闭塑形,颅内外架桥6个,颈动脉结扎2个,动脉瘤包裹1个。根据GOS评分,42例预后良好（GOS4~5分）,3例预后差（GOS2~3分）,1例死亡（GOS1分）。结论根据床突旁动脉瘤的不同特征,采用相应的策略处理动脉瘤,能提高床突旁动脉瘤的临床疗效。

Objective To investigate the surgical strategies of paraclinoid aneurysms and analyze its clinical outcomes. Methods Clinical data about 46 patients with paraclinoid aneurysm who were surgically treated in our hospital from January 2010 to May 2014 were retrospectively analyzed. Of the 46 patients with total 49 aneurysms, 8 were males, 38 were females with the mean age of 50.15 years （range： 22-72）. 17 patients had ruptured aneurysm and 9 patients had multiple aneurysms. There were 22 ophthalmic aneurysms, 10 globe aneurysms, 8 superior hypophyseal aneurysms, 3 carotid cave aneurysms, 1 serpentine aneurysm and 5 pseudoaneurysms. The diameters of 20 aneurysms were smaller than 5 mm, 15 were between 5 mm and 15 mm, and 14 aneurysms were larger than 15 ram. Surgical strategies included simple clipping, clip reconstruction, extracranial-to-intracranial （EC-IC） bypass, cervical ICA ligation and aneurysm wrapping. Clinical outcome was evaluated by Glasgow outcome scale （GOS）. Results 19 aneurysms were clipped, 21 aneurysms were treated by clip reconstruction, 6 aneurysms were treated by EC-IC bypass, 2 aneurysms were treated by cervical ICA ligation, and 1 aneurysm was treated by wrapping. According to the GOS, 42 patients had good outcomes （GOS 4, 5）, 3 had poor outcomes （GOS 2, 3） and 1 was dead （GOS 1）. Conclusion According to the individual characteristics of paraclinoid aneurysm, appropriate surgical strategies for patients are applied, which can improve the clinical outcomes.