颈内动脉血泡样动脉瘤的外科治疗

Surgical treatment of the blood blister-like aneurysm of the carotid artery

目的:比较颈内动脉血泡样动脉瘤行血管内治疗和开颅夹闭术的疗效。方法:回顾性分析2018年1月至2020年9月恩施土家族苗族自治州中心医院神经外科收治的6例破裂血泡样动脉瘤患者的临床资料,所有患者均有蛛网膜下腔出血,根据患者实际情况行开颅夹闭术或血管内治疗。行开颅夹闭术患者术后3个月复查头颈CTA,行血管内治疗患者术后6个月复查脑血管DSA。每3个月通过电话或门诊随访,进行改良Rankin量表(mRS)评分。结果:6例患者中,行开颅夹闭术3例,行血管内介入治疗3例。mRS评分0分3例,1分2例,3分1例。随访时间为6~24个月,随访期间6例均未复发或发生再出血。结论:颈内动脉血泡样动脉瘤行血管内治疗和开颅夹闭术的治疗风险都较高,但若给予合理处理,仍可取得较好疗效。

Objective:To explore the efficacy of endovascular treatment and craniotomy for the blood blister-like aneurysm of the carotid artery.Methods:The clinical data of 6 patients with ruptured bullous aneurysms in the Department of Neurosurgery,the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from January 2018 to September 2020 were retrospectively analyzed,all patients had subarachnoid hemorrhage,and were given clip or craniotomy according to the actual situations.CTA of head and neck was reexamined 3 months after craniotomy,DSA was reexamined 6 months after endovascular treatment.Telephone or outpatient follow-up was performed and mRS score was evaluated every 3 months.Results:Among the 6 patients,3 patients were given craniotomy clipping therapy and 3 patients were given endovascular interventional therapy.The mRS score was 0 in 3 cases,1 in 2 cases,and 3 in 1 case.The follow-up time was 6-24 months.No recurrence or rebleeding was found in 6 patients with DSA or CTA.Conclusions:Both endovascular therapy and craniotomy clipping for the blood blister-like aneurysm of the carotid artery have high treatment risks.if reasonable treatment is given,better efficacy can still be achieved.