Linskey M E, Sekhar L N, Horton J A, Hirsch W L, Yonas H
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
J Neurosurg. 1991 Oct;75(4):525-34. doi: 10.3171/jns.1991.75.4.0525.
Of 43 cavernous sinus aneurysms diagnosed over 6 1/2 years, 23 fulfilled indications for treatment; of these 19 were treated, eight surgically and 11 with interventional radiological techniques. Six small and two giant aneurysms were treated surgically: four were clipped, two were repaired primarily, and two were trapped with placement of a saphenous-vein bypass graft. Seven large and four giant aneurysms were treated with interventional radiological techniques: in five cases the proximal internal carotid artery (ICA) was sacrificed; one aneurysm was trapped with detachable balloons; and five were embolized with preservation of the ICA lumen. The mean follow-up period was 25 months. At follow-up examination, three patients in the surgical group were asymptomatic, two had improved, and three had worsened. Three of these patients had asymptomatic infarctions apparent on computerized tomography (CT) scans. At follow-up examination, four radiologically treated patients were asymptomatic, five had improved, two were unchanged, and none had worsened. One patient had asymptomatic and one minimally symptomatic infarction apparent on CT scans; both lesions were embolic foci after aneurysm embolization with preservation of the ICA. It is concluded that treatment risk depends more on the adequacy of collateral circulation than on the size of the aneurysm. A multidisciplinary treatment protocol for these aneurysms is described, dividing patients into high-, moderate-, and low-risk groups based on pretreatment evaluation of the risk of temporary or permanent ICA occlusion using a clinical balloon test occlusion coupled with an ICA-occluded stable xenon/CT cerebral blood flow study. Radiological techniques are suggested for most low-risk patients, while direct surgical techniques are proposed for most moderate- and high-risk patients.
在6年半的时间里诊断出43例海绵窦动脉瘤，其中23例符合治疗指征；这23例中19例接受了治疗，8例采用手术治疗，11例采用介入放射技术治疗。6例小型和2例大型动脉瘤接受了手术治疗：4例进行了夹闭，2例进行了一期修复，2例采用隐静脉搭桥移植术并进行了血管内栓塞。7例大型和4例巨型动脉瘤采用介入放射技术治疗：5例患者牺牲了颈内动脉近端；1例动脉瘤采用可脱性球囊栓塞；5例在保留颈内动脉管腔的情况下进行了栓塞。平均随访期为25个月。随访检查时，手术组3例患者无症状，2例症状改善，3例症状恶化。其中3例患者在计算机断层扫描（CT）上显示有无症状性梗死。随访检查时，介入放射治疗组4例患者无症状，5例症状改善，2例无变化，无患者症状恶化。1例患者在CT上显示有无症状性梗死，1例有轻微症状性梗死；这两个病变均为保留颈内动脉的动脉瘤栓塞后的栓塞灶。结论是，治疗风险更多地取决于侧支循环的充分程度，而不是动脉瘤的大小。本文描述了这些动脉瘤的多学科治疗方案，根据使用临床球囊闭塞试验结合颈内动脉闭塞稳定氙/CT脑血流研究对临时或永久性颈内动脉闭塞风险的术前评估，将患者分为高、中、低风险组。建议对大多数低风险患者采用放射技术，而对大多数中、高风险患者采用直接手术技术。
