自体硬脑膜包裹夹闭术治疗颈内动脉血泡样动脉瘤的临床疗效

Clinical efficacy of dural wrapping and clipping technique in the treatment of blood blister-like aneurysms of internal carotid artery

目的探讨采用显微镜下自体硬脑膜包裹夹闭术治疗颈内动脉血泡样动脉瘤(BBA)的临床疗效。方法回顾性分析1996年10月至2019年12月青岛大学附属医院神经外科采用自体硬脑膜包裹夹闭术治疗的颈内动脉破裂BBA患者的临床资料,共17例(17个责任动脉瘤和2个非责任动脉瘤)。其中Hunt-Hess分级Ⅱ级者11例,Ⅲ级者6例。根据动脉瘤的发出位置对BBA进行分型,不同分型采用不同的硬脑膜包裹方式。所有患者术后1个月及出院后5个月行CT血管成像(CTA)或数字减影血管造影(DSA)检查,采用格拉斯哥预后评级(GOS)评估术后疗效。结果17例患者的19个动脉瘤均成功夹闭。术中放置动脉瘤瘤夹时动脉瘤破裂7例,均未发生严重的并发症。术后CT检查显示,1例发生颞叶部分梗死致左侧肢体活动障碍,1例发生患侧内囊膝部梗死导致对侧下肢轻瘫。17例患者的随访时间为5~140个月(中位数为36个月)。随访结果显示,GOSⅤ级者15例,2例术后发生脑梗死者经康复训练后GOS为Ⅳ级;头颅CTA或DSA检查未见动脉瘤复发。结论采用显微镜下自体硬脑膜包裹夹闭术治疗颈内动脉破裂BBA的并发症发生率低,疗效好。

Objective To explore the clinical efficacy of dural wrapping and clipping technique in the treatment of blood blister-like aneurysms(BBA)of internal carotid artery(ICA).Methods Between October 1996 and December 2019,17 cases of ruptured BBA were treated with autologous dura mater and clipping technique at Department of Neurosurgery,Affiliated Hospital of Qingdao University.The clinical data(including 17 associated aneurysms and 2 non-associated aneurysms)were retrospectively analyzed.There were 11 cases of Hunt-Hess gradeⅡand 6 cases of gradeⅢ.BBA was classified according to the location of aneurysms.Different dural wrapping techniques were used for different types of lesions.All patients underwent CTA or DSA 1 month after operation and 5 months after discharge.Glasgow Outcome Scale(GOS)was used to assess the clinical efficacy.Results All 19 aneurysms of 17 patients were successfully clipped.Seven cases of aneurysm rupture occurred during the placement of aneurysm clips during operation,and no serious complications occurred.Postoperative CT examination showed that one case had a partial infarction in the temporal lobe,which resulted in dysfunction of the left limb,and one case had a small infarction in the knee of ipsilateral internal capsule,which resulted in moderate paresis of contralateral lower limb.The follow-up duration of 17 patients ranged from 1 to 100 months with a median of 36 months.The follow-up results showed that there were 15 cases with GOS gradeⅤ.GOS gradeⅣwas reported in two patients who developed cerebral infarction after surgery and underwent rehabilitation.No recurrence of aneurysm was identified based on review of CTA or DSA.Conclusion Microsurgical dural wrapping with autologous dura and clipping technique is associated with low complication rate and can result in good outcomes for the treatment of BBA.