Thorell William, Rasmussen Peter, Perl John, Masaryk Thomas, Mayberg Marc
Section of Endovascular Neurosurgery, Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Neurosurg. 2004 Apr;100(4):713-6. doi: 10.3171/jns.2004.100.4.0713.
Paraclinoid aneurysms represent a significant surgical challenge. Multiple techniques have been developed to maximize the effectiveness and safety of excluding these aneurysms from the cerebral circulation. Endovascular balloons have been used for proximal control of parent arteries during the treatment of aneurysms. In this report the authors describe the technique of navigating an endovascular balloon across the neck of paraclinoid aneurysms in four patients to gain proximal control, improve the accuracy of clip placement, and reduce the risk of distal embolization of intraluminal thrombus. Six consecutive patients with giant or complex aneurysms of the ophthalmic or paraclinoid internal carotid artery that were not amenable to endovascular obliteration were retrospectively analyzed. In all six patients, the aneurysm was exposed and dissected for microsurgical clipping, and attempts were made to navigate a nondetachable, compliant silicone balloon across the neck of the aneurysm. If successfully placed, the balloon was inflated during clip placement. In four patients, the balloon was successfully navigated across the neck of the aneurysm and was inflated during clip application. Internal carotid artery tortuosity precluded navigation of the balloon into the intracranial circulation in two patients. All aneurysms were completely excluded from the parent vessel according to postoperative angiography studies. No complication occurred as a direct result of the endovascular portion of the procedure. Endovascular balloon stenting of complex paraclinoid aneurysms during microvascular clipping may provide an adjunctive therapy that facilitates safe and accurate clip placement.
床突旁动脉瘤是一项重大的外科挑战。已开发出多种技术以最大限度地提高将这些动脉瘤从脑循环中排除的有效性和安全性。血管内球囊已用于在动脉瘤治疗期间对载瘤动脉进行近端控制。在本报告中，作者描述了在4例患者中引导血管内球囊穿过床突旁动脉瘤颈部以实现近端控制、提高夹闭准确性并降低腔内血栓远端栓塞风险的技术。对6例连续的患有眼动脉或床突旁颈内动脉巨大或复杂动脉瘤且不宜进行血管内闭塞治疗的患者进行了回顾性分析。在所有6例患者中，均暴露并解剖动脉瘤以进行显微外科夹闭，并尝试引导一个不可拆卸的顺应性硅胶球囊穿过动脉瘤颈部。如果成功放置，在夹闭时将球囊充气。在4例患者中，球囊成功穿过动脉瘤颈部并在夹闭时充气。在2例患者中，颈内动脉迂曲妨碍球囊进入颅内循环。根据术后血管造影研究，所有动脉瘤均完全与载瘤血管隔绝。手术的血管内部分未直接导致任何并发症。在微血管夹闭期间对复杂床突旁动脉瘤进行血管内球囊支架置入术可能提供一种辅助治疗方法，有助于安全准确地进行夹闭。
