临时动脉瘤口球囊闭塞术作为巨大海绵窦段颈内动脉瘤逆行抽吸减压术的替代方法：技术说明
Temporary aneurysm orifice balloon occlusion as an alternative to retrograde suction decompression for giant paraclinoid internal carotid artery aneurysms: technical note.
作者信息
Steiger Hans-Jakob, Lins Farias, Mayer Thomas, Schmid-Elsaesser Robert, Stummer Walter, Turowski Bernd
机构信息
Department of Neurological Surgery, Heinrich-Heine-Universität, Moorenstrasse 5, Düsseldorf, Germany.
出版信息
Neurosurgery. 2005 Apr;56(2 Suppl):E442; discussion E442. doi: 10.1227/01.neu.0000157102.01803.8c.
OBJECTIVE
Giant paraclinoid carotid artery aneurysms frequently require the temporary interruption of local circulation to facilitate safe clip occlusion. Owing to the brisk retrograde blood flow through the ophthalmic artery and cavernous branches, the simple trapping of the aneurysm by cervical internal carotid artery clamping and intracranial distal clipping may not adequately soften the lesion. Retrograde suction decompression aspiration of this collateral supply by a catheter introduced into the cervical internal carotid artery is a popular method to achieve aneurysm deflation. With a large collateral supply, the method is not effective enough. The advent of relatively long and maneuverable soft balloons allows temporary occlusion of the aneurysm orifice.
METHODS
We applied this method in two instances of giant carotid ophthalmic aneurysms. In both instances, a 15- to 20-mm-long and 4-mm-wide occlusion balloon was inserted in the internal carotid artery at the level of the aneurysm before craniotomy. After craniotomy and dissection of the aneurysm neck, the balloon was inflated under intraoperative angiographic control.
RESULTS
The aneurysm became soft enough in both cases without tapping and aspiration to allow safe clip occlusion. In the first case, the postoperative course was uneventful and visual acuity improved. A known additional infraclinoid part of the aneurysm was eliminated endovascularly 5 months later using balloon-protected injection of vinyl alcohol copolymer (Onyx; Micro Therapeutics, Inc., Irvine, CA). In the second case, a postoperative symptomatic vasospasm developed 15 hours after surgery. Hypertensive therapy resulted in the disappearance of symptoms and an otherwise uneventful course with improvement of vision.
CONCLUSION
This preliminary experience suggests that this new method is a feasible alternative to retrograde suction decompression.
目的
巨大海绵窦旁颈内动脉瘤常常需要临时阻断局部循环以利于安全夹闭。由于通过眼动脉和海绵窦分支的逆向血流活跃，单纯通过夹闭颈内动脉和颅内远端夹闭来阻断动脉瘤可能无法充分使瘤体软化。经颈内动脉插入导管对这种侧支供血进行逆向抽吸减压是使动脉瘤瘪陷的常用方法。对于侧支供血丰富的情况，该方法效果不够理想。相对较长且可操控的柔软球囊的出现使得能够临时封堵动脉瘤开口。
方法
我们将此方法应用于两例巨大颈内动脉眼动脉瘤。在这两例中，在开颅手术前，于动脉瘤水平将一个15至20毫米长、4毫米宽的封堵球囊插入颈内动脉。开颅并解剖动脉瘤颈后，在术中血管造影控制下充盈球囊。
结果
两例中动脉瘤均变得足够柔软，无需穿刺抽吸即可安全夹闭。第一例术后过程顺利，视力改善。5个月后，通过球囊保护下注射乙烯醇共聚物（Onyx；Micro Therapeutics公司，加利福尼亚州欧文市）经血管内消除了动脉瘤一个已知的额外海绵窦下部分。第二例术后15小时出现有症状的血管痉挛。高血压治疗使症状消失，术后过程顺利，视力改善。
结论
这一初步经验表明，这种新方法是逆向抽吸减压的一种可行替代方法。
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