球囊辅助阻断技术在栓塞术后复发的床突旁大型动脉瘤夹闭手术中的应用

Application of balloon-assisted blocking echnique in clipping of large paraclinoid aneurysms recurrent after embolization

目的探讨球囊辅助阻断技术在栓塞术后复发的床突旁大型动脉瘤夹闭手术中的临床应用效果。方法回顾性分析2017年7月至2020年6月武汉大学中南医院神经外科收治的10例栓塞后复发的床突旁大型动脉瘤患者的临床资料。动脉瘤的最大径为(17.5±5.6)mm(11~26 mm)。10例动脉瘤均应用球囊辅助阻断技术行开颅夹闭术,其球囊放置和开颅夹闭术均在一站式复合手术室同期进行。术后即刻行数字减影血管造影(DSA)观察动脉瘤的夹闭情况以及载瘤动脉的通畅情况。随访期间行DSA检查评估动脉瘤的闭塞和复发情况;采用改良Rankin量表评分(mRS)评估患者的预后。结果10例动脉瘤均在术中成功置入球囊并对动脉瘤颈进行封堵,安全取出瘤颈处残留的弹簧圈及血栓,成功塑形并夹闭动脉瘤。术后即刻DSA检查显示,10例动脉瘤均完全闭塞,无瘤颈残留、载瘤动脉狭窄和大血管栓塞等事件发生,无死亡病例。出院时mRS 0分7例,1分3例,患者均未发生迟发性视力障碍。10例患者的随访时间为(29.7±8.5)个月(13~48个月)。术后6个月行DSA复查显示,所有患者的动脉瘤完全闭塞,无动脉瘤残留和复发。末次随访显示,mRS 0分9例,1分1例。结论对于栓塞术后复发的床突旁大型动脉瘤,采用球囊辅助阻断技术夹闭动脉瘤的成功率高,术后并发症少,患者预后良好,是一种安全、有效的复合手术方法。

Objective To explore the clinical application effect of balloon-assisted blocking technique in clipping surgery for large paraclinoid aneurysms recurrent after embolization.Methods The clinical data of 10 patients with recurrent large paraclinoid aneurysms after embolization who were admitted to the Department of Neurosurgery of Zhongnan Hospital of Wuhan University from July 2017 to June 2020 were retrospectively analyzed.The maximum diameter of the aneurysm was 17.5±5.6 mm(11-26 mm).All 10 cases of aneurysms underwent craniotomy and clipping with balloon-assisted blocking technique,and the balloon placement and craniotomy and clipping were performed simultaneously in a one-stop hybrid operating room.Immediately after operation,digital subtraction angiography(DSA)was performed to observe the clipping condition of the aneurysm and the patency of the parent artery.During the follow-up period,DSA examination was performed to evaluate the occlusion and recurrence of the aneurysm;the modified Rankin scale(mRS)was used to evaluate the outcomes of the patients.Results In all 10 cases of aneurysm,a balloon was successfully placed and the neck of the aneurysm was blocked,and the residual coil and thrombus at the neck of the aneurysm were safely removed,and the aneurysm was successfully shaped and clipped.Immediately after the operation,DSA examination showed that all 10 cases of aneurysms were completely occluded,and there were no residual aneurysms,parent artery stenosis,or large vessel embolism,and no death cases occurred.There were 7 cases with mRS score of 0 and 3 cases with mRS score of 1 at discharge.No delayed visual impairment occurred in any of the patients.The follow-up time of 10 patients was 29.7±8.5 months(13-48 months).DSA reexamination at 6 months after operation showed that the aneurysm was completely occluded in all patients,and there was no residual aneurysm or recurrence.At the last follow-up,the mRS score was 0 in 9 cases and 1 in 1 case.Conclusion For large paraclinoid aneurysms that recur after embolization,surgical clipping with balloon-assisted blocking technique has a high success rate,fewer postoperative complications,and good prognosis,which seems to be a safe and effective hybrid surgery method.