摘要
目的探讨颈内动脉海绵窦段巨大动脉瘤的手术方法和影响疗效因素。方法 2008年7月至2010年10月共收治颈内动脉海绵窦段巨大动脉瘤12例,其中多发3例,均行颅内外高流量旁路移植术及动脉瘤孤立术。移植血管为大隐静脉6例,桡动脉6例。供血动脉为颈外动脉主干10例,颌内动脉2例。受血动脉为大脑中动脉颞干11例,颈内动脉眼动脉段1例。结果术后随访0.5～2.7年,按GOS评分,11例恢复良好,1例重残。影像学复查示移植血管通畅10例,闭塞2例(其中1例为二次手术后闭塞)。结论颅内外高流量血管旁路移植术+动脉瘤孤立术是治疗颈内动脉海绵窦段巨大动脉瘤的理想方法,尤其是对于较年轻的患者;合理选择供血动脉、移植血管和受血动脉,加强围手术期的监护和处理,保证移植血管的通畅,是手术成功的关键。
Objective To explore the surgical technique of the treatment of the giant aneurysms of internal carotid artery cavernous segment（ICA-CS）and the factors influencing its curative effect.Methods The high-flow extracranial and intracranial arteries bypass surgery with great saphenous veins or radial arteries and trapping of the aneurysms were performed in 12 patients with 15 giant aneurysms of ICA-CS.Of 12 patients with giant aneurysms of ICA-CS,6 underwent external carotid artery（ECA）-saphenous vein-middle cerebral artery（MCA）bypass,3 ECA-radial artery-MCA,1 ECA-radial artery-ophthalmic artery and 2 internal maxillary artery-radial artery-MCA.Results The follow-up from 0.5 to 2.7 years showed that,11 patients were recovered well and 1 was severely disabled according to GOS.The postoperative imaging examination showed that the vascular grafts were clear in 10 cases and were occluded in 2 cases.Conclusions The high-flow extracranial-intracranial bypass combined with aneurysm trapping is a good method to treat the giant aneurysms of ICA-CS.Choosing the matched extracranial arteries with intracranial arteries for the bypass and grafted vessels,enhancing the nursing and management during the perioperative period,and keeping the grafted vessels clear are very important to good outcomes in the patients with giant aneurysms of ICA-CS undergoing the extracranial and intracranial bypass.
出处
《中国临床神经外科杂志》
2011年第10期577-580,共4页
Chinese Journal of Clinical Neurosurgery
关键词
动脉瘤
颈内动脉
海绵窦段
颅内外血管旁路移植术
孤立术
Aneurysms
Cavernous segment
Internal carotid artery
Extracranial and intracranial arteries bypass
Trapping
