球囊辅助夹闭术治疗颅内大型和巨大型动脉瘤

Outcomes of balloon-assisted clipping for large and giant intracranial aneurysms

目的 探讨球囊辅助夹闭术治疗颅内大型和巨大型动脉瘤(LGIAs)的疗效。方法 回顾性分析2017~2020年在复合手术室行球囊辅助夹闭术治疗的32例LGIAs的临床资料。结果 32例共32个LGIAs,其中大型动脉瘤(直径15~25 mm)22例,巨大型动脉瘤(直径≥25 mm)10例。32例中,23例球囊放置在颈内动脉近心端,9例放置在动脉瘤颈部;11例因术中造影示动脉瘤颈残留而调整动脉瘤夹位置,2例术中造影示载瘤动脉狭窄而调整动脉瘤夹位置,8例扩张球囊后动脉瘤并没有很好的解除压力而反向抽吸血流后成功夹闭;术后即刻造影显示完全或近完全闭塞率是100%。5例术中动脉瘤再破裂,出血量在400 ml以下,没有发生很严重的出血。术后13例出现短期神经功能障碍,6例表现出长期神经功能缺损。出院时GOS评分4~5分14例,1~3分18例。2例失访,2例死亡,剩余28例随访3~25个月(中位数12.5个月),影像随访显示动脉瘤完全和近完全闭塞27例(96.4%),1例复发;末次随访,改良Rankin量表评分0~2分23例,3~5分5例。结论 球囊辅助夹闭术治疗LGIAs是一种有效的方式,成功夹闭率高,病死率低,预后良好。

Objective To explore the efficacy of balloon-assisted clipping for large and giant intracranial aneurysms(LGIAs).Methods The clinical dat of 32 patients with LGIA who underwnt balloon-assisted clipping in the hybrid operation room between 2017and 2020 were analyzed retrospectively. Results Thirty-two patients had 32 LGIAs, including 22 large aneurysms(diameter, 15~25 mm)and 10 giant aneurysms(diameter, ≥25 mm). All the patients underwent balloon-assisted clipping, of which 23 balloms were placed at the proximal end of the internal carotid artery, and 9 at the neck of the aneurysm. During the operation, the clips were adjusted in 11patients due to the residual aneurysm neck, and in 2 due to the stenosis of parent artery. The aneurysms were successfully clipped in 8patients after reverse suction of the blood flow because the aneurysms were not well relieved after the balloons were expanded.Immediate angiography after clipping showed a complete or near-complete occlusion rate of 100%. Intraoperative aneurysm rupture occurred in 5 patients, of whom the blood loss was less than 400 ml. Short-term neurological dysfunction occurred in 13 patients and long-term neurological deficit in 6 patients after surgery. On discharge, the GOS score of 4~5 was achieved in 14 patients and score of1~3 in 18. Two patients were lost to follow-up, and 2 died. Twenty-eight patients were followed up for 3~25 months, with a median of 12.5 months. Imaging follow-up showed complete occlusion of aneurysm in 27 patients(96.4%) and recurrence of aneurysm in 1. At the last follow-up, the modified Rankin scale score of 0~2 was achieved in 23 patients and score of 3~5 in 5. Conclusions Balloon-assisted clipping is an effective method for the treatment of LGIAs, which has high successful clipping rate, low mortality and good prognosis.