Joo Sung-Pil, Kim Tae-Sun, Moon Kyung-Sub, Kwak Hyoung-Jun, Lee Jung-Kil, Kim Jae-Hyoo, Kim Soo-Han
Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
Surg Neurol. 2006 Oct;66(4):424-8; discussion 428-9. doi: 10.1016/j.surneu.2006.01.024. Epub 2006 Jul 21.
Blister-like aneurysms of the internal carotid artery (ICA) are very fragile, thin-walled aneurysms. These lesions are susceptible to premature rupture intraoperatively. We describe two cases of successful arterial suturing of these blister-like aneurysms of the ICA, followed by a clip reinforcement technique and circumferential wrapping with a silastic sheet.
Two young men presented with a diffuse and dense subarachnoid hemorrhage (SAH) in the basal cistern. The initial angiogram obtained soon after the SAH showed a broad-based, small bulging appearance of the dorsal wall of the ICA. Intraoperatively, a very thin-walled aneurysm was identified on the C2 and C1 segment of the ICA. The aneurysms ruptured abruptly during surgical manipulation. After application of temporary clips, an aneurysmal tear of the ICA was repaired with 8-0 nylon. To prevent the regrowth of the aneurysm, clip reinforcement, by circumferential wrapping with a transparent silicone sheet, was added.
The postoperative clinical course was uneventful, although one patient showed transient right hemiparesis due to cerebral vasospasm. Angiographic studies performed postoperatively showed complete obliteration of the aneurysm as well as a patent ICA lumen in one case and total occlusion of the ICA in the other case. Both patients were discharged with no neurological deficits.
This technique can be a useful treatment option for these fragile aneurysms in cases where other options, such as direct clips or encircling clips, may be impossible.
颈内动脉（ICA）的水泡样动脉瘤是非常脆弱的薄壁动脉瘤。这些病变在术中易过早破裂。我们描述了两例成功对ICA的这些水泡样动脉瘤进行动脉缝合的病例，随后采用夹闭加固技术并用硅橡胶片进行环周包裹。
两名年轻男性表现为基底池弥漫性致密蛛网膜下腔出血（SAH）。SAH后不久获得的初始血管造影显示ICA后壁有宽基底、小的膨出外观。术中，在ICA的C2和C1段发现一个非常薄壁的动脉瘤。在手术操作过程中动脉瘤突然破裂。应用临时夹闭后，用8-0尼龙线修复ICA的动脉瘤撕裂。为防止动脉瘤复发，通过用透明硅橡胶片环周包裹进行夹闭加固。
术后临床过程平稳，尽管一名患者因脑血管痉挛出现短暂性右侧偏瘫。术后血管造影研究显示一例动脉瘤完全闭塞且ICA管腔通畅，另一例ICA完全闭塞。两名患者均无神经功能缺损出院。
在其他选择（如直接夹闭或环绕夹闭）可能无法实施的情况下，该技术对于这些脆弱的动脉瘤可能是一种有用的治疗选择。
