Son Hee Eon, Park Moon Sun, Kim Seong Min, Jung Sung Sam, Park Ki Seok, Chung Seung Young
Department of Neurosurgery, School of Medicine, Eulji University, Daejeon, Korea.
J Korean Neurosurg Soc. 2010 Sep;48(3):199-206. doi: 10.3340/jkns.2010.48.3.199. Epub 2010 Sep 30.
Paraclinoid segment internal carotid artery (ICA) aneurysms have historically been a technical challenge for neurovascular surgeons. The development of microsurgical approach, advances in surgical techniques, and endovascular procedures have improved the outcome for paraclinoid aneurysms. However, many authors have reported high complication rates from microsurgical treatments. Therefore, the present study reviews the microsurgical complications of the extradural anterior clinoidectomy for treating paraclinoid aneurysms and investigates the prevention and management of observed complications.
Between January 2004 and April 2008, 22 patients with 24 paraclinoid aneurysms underwent microsurgical direct clipping by a cerebrovascular team at a regional neurosurgical center. Microsurgery was performed via an ipsilateral pterional approach with extradural anterior clinoidectomy. We retrospectively reviewed patients' medical charts, office records, radiographic studies, and operative records.
IN OUR SERIES, THE CLINICAL OUTCOMES AFTER AN IPSILATERAL PTERIONAL APPROACH WITH EXTRADURAL ANTERIOR CLINOIDECTOMY FOR PARACLINOID ANEURYSMS WERE EXCELLENT OR GOOD (GLASGOWS OUTCOME SCALE : GOS 5 or 4) in 87.5% of cases. The microsurgical complications related directly to the extradural anterior clinoidectomy included transient cranial nerve palsy (6), cerebrospinal fluid leak (1), worsened change in vision (1), unplanned ICA occlusion (1), and epidural hematoma (1). Only one of the complications resulted in permanent morbidity (4.2%), and none resulted in death.
Although surgical complications are still reported to occur more frequently for the treatment of paraclinoid aneurysms, the permanent morbidity and mortality resulting from a extradural anterior clinoidectomy in our series were lower than previously reported. Precise anatomical knowledge combined with several microsurgical tactics can help to achieve good outcomes with minimal complications.
蝶骨平台段颈内动脉（ICA）动脉瘤一直以来都是神经血管外科医生面临的一项技术挑战。显微手术入路的发展、手术技术的进步以及血管内治疗方法改善了蝶骨平台动脉瘤的治疗效果。然而，许多作者报告显微手术治疗的并发症发生率较高。因此，本研究回顾了经硬膜外前床突切除术治疗蝶骨平台动脉瘤的显微手术并发症，并探讨了对观察到的并发症的预防和处理。
2004年1月至2008年4月期间，一个地区神经外科中心的脑血管团队对22例患有24个蝶骨平台动脉瘤的患者进行了显微手术直接夹闭。显微手术通过同侧翼点入路并经硬膜外前床突切除术进行。我们回顾性地查阅了患者的病历、门诊记录、影像学研究和手术记录。
在我们的系列研究中，经同侧翼点入路并经硬膜外前床突切除术治疗蝶骨平台动脉瘤后的临床结果在87.5%的病例中为优或良（格拉斯哥预后量表：GOS 5或4）。与硬膜外前床突切除术直接相关的显微手术并发症包括短暂性脑神经麻痹（6例）、脑脊液漏（1例）、视力恶化（1例）、计划性外颈内动脉闭塞（1例）和硬膜外血肿（1例）。只有1例并发症导致永久性致残（4.2%），无1例导致死亡。
尽管据报道治疗蝶骨平台动脉瘤时手术并发症仍更频繁地发生，但在我们的系列研究中，经硬膜外前床突切除术导致的永久性致残率和死亡率低于先前报道。精确的解剖学知识与多种显微手术策略相结合有助于以最少的并发症获得良好的治疗效果。
