颅底肿瘤术中颈内动脉损伤的防治

Prevention and management of internal carotid artery injury during operation for patients with skull base tumor

目的探讨颅底肿瘤切除术中颈内动脉损伤的紧急处理方法及预防措施。方法回顾性分析2011年1月至2021年1月因手术致颈内动脉损伤的8例颅底肿瘤的临床资料,总结术中颈内动脉损伤的紧急处理措施和预防方法。结果8例中,蝶骨嵴膜脑瘤2例,前床突脑膜瘤2例,鞍结节脑膜瘤2例,海绵窦脑膜瘤1例,侵袭性垂体腺瘤1例。7例脑膜瘤中,3例临时阻断后缝合破口成功止血(1例半个月后复查DSA发现假性动脉瘤形成,行颈内动脉覆膜支架置入术),2例颈内动脉微小破口使用双极电灼成功止血,2例填塞压迫及电凝止血失败后行颈内动脉夹闭术(1例因失血性休克死亡)。1例侵袭性垂体腺瘤以凡士林纱条填塞止血后立即行颈内动脉覆膜支架置入术。术后随访12个月,止血成功的7例中,恢复良好6例,重残1例。结论颅底肿瘤术中颈内动脉损伤的关键在于预防;一旦发生,及时有效的止血并修复血管,可有效降低手术风险,改善病人预后。

Objective To discuss the emergency management and preventive measures for the internal carotid artery(ICA)injury during the operation for the patients with skull base tumor.Methods The clinical data of 8 patients with skull base tumor whose ICA was injuried during the resection of the skull base tumors from January 2011 to January 2021 were analyzed retrospectively.The emergency management and preventive methods of ICA injury were summarized.Results Of these 8 patients,7 suffered from meningiomas(3 sphenoid ridge meningiomas,2 clinoidal meningiomas and 2 tuberculum sellae meningiomas)and 1 suffered from invasive pituitary adenoma.Of 7 patients with meningioma,3 patients received the suture of breach after temporarily blocking the ICA to successfully stop the bleeding(1 patient had pseudoaneurysm 2 weeks after the suture of breach and received implantation of covered stent),2 received bipolar electrocautery to successfully stop the bleeding,2 recieved clipping of the ICA after the failure of packing compression and electrocoagulation to stop bleeding(1 patient died of hemorrhagic shock).One patient with invasive pituitary adenoma received implantation of covered stent after filling with petrolatum gauze to stop bleeding.The follow-up results(12 months)showed that 6 patients were recovered well and 1 was severely disabled of 7 patients receiving successful stopping of the bleeding.Conclusions The key to ICA injury during the resection of the skull base tumors is prevention.Once it occurs,timely and effective measures to stop bleeding and to repair the ICA can effectively reduce the risk of surgery for the skull base tumors and improve the patients'prognoses.