床突旁动脉瘤的显微手术治疗（附20例报告）

Microsurgical treatment of paraclinoid aneurysms： A report of 20 cases

目的探讨床突旁动脉瘤的显微手术治疗策略和疗效。 方法回顾性分析2015年11月至2017年3月重庆医科大学附属第一医院神经外科采用显微手术治疗的20例床突旁动脉瘤患者的临床资料，手术方式包括单纯夹闭术、瘤颈夹闭术及载瘤动脉塑形术。术后复查头颅CT血管成像（CTA）或数字减影血管造影（DSA），观察动脉瘤夹闭情况，出院时采用格拉斯哥预后评级（GOS）评估临床疗效。对所有患者行门诊或电话随访，随访内容为GOS，评估患者预后。 结果20例患者的动脉瘤均获得满意夹闭。术后CTA或DSA检查发现，所有患者均无动脉瘤复发及再出血，仅1例瘤颈存在少量残留。术后1例巨大动脉瘤患者出现严重脑水肿并发脑积水，6例发生症状性脑血管痉挛，3例发生脑梗死，1例发生脑脊液鼻漏，3例新发视力、视野损害，经治疗均改善或恢复正常。围手术期无死亡。出院时GOS评级，Ⅴ级13例，Ⅳ级6例，Ⅲ级1例。20例患者均获得随访，随访时间为1～18个月，平均（10±6）个月。GOS评级，Ⅴ级16例，Ⅳ级4例。 结论对床突旁动脉瘤行显微外科夹闭术安全可行，可获得良好的治疗效果。

ObjectiveTo investigate the microsurgical strategy and efficacy of paraclinoid aneurysms. MethodsThe clinical data of 20 patients with paraclinoid aneurysms were retrospectively reviewed who underwent microsurgical clipping from November 2015 to March 2017 at Neurosurgery Department of the First Affiliated Hospital of Chongqing Medical University. The operative methods included simple clipping and clipping of aneurismal neck and parent artery reconstruction. After the operation, the aneurysm clipping was examined by CTA or DSA, and the Glasgow prognosis score （GOS） was used to evaluate the clinical effect. All patients were followed up by outpatient clinic or telephone, and the GOS scale was used to assess the patient＇s prognosis. ResultsAll patients achieved satisfactory results. There was no aneurysm recurrence or rebleeding in this series detected by CTA or DSA. Only 1 case of unruptured aneurysm had a small residual neck after treatment. There was no death during the perioperative period. The GOS grade was Ⅴ in 13 cases, Ⅳ in 6 and Ⅲ in 1 at discharge. All patients were followed up for a period of 1-18 months, with an average of 10±6 months. The GOS grade was Ⅴ in 16 cases and Ⅳ in 4 cases. ConclusionMicrosurgical clipping of paraclinoid aneurysm seems to be safe and feasible, which could have a favorable outcome.