逆向抽空减压法治疗颅内巨大动脉瘤3例

Retrograde suction decompression for the treatment of giant intracranial aneurysms

目的 探讨和评价逆向抽空减压法治疗颅内巨大动脉瘤的临床治疗效果。 方法采用逆向抽空减压法对3例颅内巨大动脉瘤患者进行手术治疗,并对其手术方法进行分析,对患者进行了随访。 结果对3例巨大动脉瘤均采用标准的翼点入路联合颈部颈动脉抽吸顺利夹闭。其中1例患者术后拒绝DSA复查,术后9个月随访患者偶有头晕,左眼视力略有好转,GOS(glasgowoutcome scale)预后分级为Ⅴ级;1例患者术后有左侧肢体不完全偏瘫,头颅CT显示右基底核缺血性改变,DSA复查示右颈部颈总动脉阻断处略狭窄,载瘤动脉通畅;术后6个月随访,GOS预后分级为Ⅳ级;另1例患者术后恢复良好,头颅CT复查显示动脉瘤夹闭完全,载瘤动脉显影良好;GOS预后分级为Ⅴ级。 结论逆向抽空减压法使部分不可直接夹闭或难以直接夹闭的颅内巨大动脉瘤变为可夹闭动脉瘤,是治疗颅内巨大动脉瘤安全有效的方法之一。

objectiveTo present and evaluate the treatment and follow-up of 3 giant intracranial a-neurysms by Retrograde suction decompression. Methods The operative technique of retrograde suction decompression of giant intracranial aneurysm in 3 patients was summarized and the prognosis were followed up. Results Three giant intracranial aneurysms were easily clipped by using a combination of standard pterional craniotomy and cervical carotid retrograde aneurysmal decompression. One of the patients refused reexamination of DSA after operation and had dizziness occasionally, a slight improvement of left eyesight and Glasgow Outcome Scale (GOS) was grade 5 at 9-month follow-up. The second one had an incomplete hemiplegia on the left limb and CT scan showed that there was ischemia at the region of the right basal ganglia, and DSA showed there was a slight stenosis at the occlusive site of the right cervical carotid and the patent artery was patent, and GOS was grade 4 at 6-month follow-up. The third one had a good outcome after operation and The reexamination of CTA showed the patent artery was patent and the aneurysm was clipped completely and the patent artery was seen clearly, GOS was grade 5 when she was out of hospital. Conclusion Retrograde suction decompression may make some unclip-pable giant intracranial aneurysms or difficult to clip it become clippable, it was one of safe and effective means for the treatment of giant intracranial aneurysms.