Charbel F T, Gonzales-Portillo G, Hoffman W, Cochran E
Department of Neurosurgery, University of Illinois at Chicago, 60612, USA.
Neurosurgery. 1999 Sep;45(3):643-8; discussion 648-9. doi: 10.1097/00006123-199909000-00043.
Small, irregular aneurysms of the internal carotid artery (ICA) that are not related to arterial divisions are rare and have characteristics similar to pseudoaneurysms: they do not appear to have well-formed sacs, they are surrounded by clot, and they avulse readily. We report two patients whose treatment demonstrates the surgical technique and important points concerning the management of distal ICA pseudoaneurysms.
Both patients presented with diffuse subarachnoid hemorrhage. The initial angiographic results were unremarkable in each case. A week after presentation, however, a growing outpouching in the distal ICA was seen.
At surgery, the aneurysms were found to be on the medial wall of the ICA and were not related to arterial divisions. Quantitative blood flow measurements of the efferent vessels at risk (ICA, M1 and A1 segments) were obtained using a perivascular microflowprobe before and after clipping. In each patient, the aneurysm avulsed entirely during clip application, despite careful placement of the clip parallel to the parent vessel. An encircling clip was then used. Pathological sectioning of the aneurysms revealed loose connective tissue and/or clot with no defined aneurysmal sac.
Aneurysms of the distal ICA that are not related to arterial divisions are difficult to visualize on angiograms immediately after subarachnoid hemorrhage. They are frail, avulse easily, and may be pseudoaneurysms, necessitating the use of encircling clips. The base of the aneurysm or clot must be trimmed to prevent it from buckling inside the clip sleeve and compromising the ICA lumen. Measuring distal blood flow quantitatively provides valuable information about the patency of the ICA inside the metallic sleeve, since this segment cannot be demonstrated with angiography.
颈内动脉（ICA）小的、不规则动脉瘤，与动脉分支无关，较为罕见，具有与假性动脉瘤相似的特征：似乎没有完整形成的瘤囊，周围有血栓形成，且易于撕裂。我们报告两例患者，其治疗展示了手术技巧及处理ICA远端假性动脉瘤的要点。
两名患者均表现为弥漫性蛛网膜下腔出血。最初的血管造影结果在每例中均无明显异常。然而，在发病一周后，发现ICA远端有一个逐渐增大的膨出。
手术中发现动脉瘤位于ICA内侧壁，与动脉分支无关。在夹闭前后，使用血管周围微流量探头对有风险的传出血管（ICA、M1和A1段）进行定量血流测量。在每例患者中，尽管小心地将夹子平行于母血管放置，但在夹闭过程中动脉瘤完全撕裂。然后使用环绕夹。对动脉瘤进行病理切片显示为疏松结缔组织和/或血栓，无明确的动脉瘤囊。
与动脉分支无关的ICA远端动脉瘤在蛛网膜下腔出血后立即进行血管造影时很难显示。它们很脆弱，容易撕裂，可能是假性动脉瘤，因此需要使用环绕夹。必须修剪动脉瘤或血栓的底部，以防止其在夹套内弯曲并压迫ICA管腔。定量测量远端血流可提供有关金属套内ICA通畅情况的有价值信息，因为该段血管造影无法显示。
