Division of Neurosurgery, Department of Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
Neurosurg Rev. 2013 Jan;36(1):99-114; discussion 114-5. doi: 10.1007/s10143-012-0415-0. Epub 2012 Aug 17.
The term "paraclinoid aneurysms", has been used for aneurysms of the internal carotid artery (ICA) between the cavernous sinus and the posterior communicating artery. Due to their complex anatomical relationship at the skull base and because they are frequently large/giant, their surgical treatment remains a challenge. Ninety-five patients harboring 106 paraclinoid aneurysms underwent surgery (1990-2010). Age, 11-72 years old. Sex, 74:21 female/male. Follow-up; 1-192 months (mean = 51.7 months). Eighty-six patients had single and 9 had multiple paraclinoid aneurysms. Sixty-six were ophthalmic, 14 were in the ICA superior wall, 13 in the inferior, 10 in the medial, and 3 in the ICA lateral wall. Eleven were giant, 29 were large, and 66 were small. Sixty-three patients had ruptured and 32 had unruptured aneurysms. Two patients with bilateral aneurysms had bilateral approaches, totaling 97 procedures. A total of 98.2% of aneurysms were clipped (complete exclusion in 93.8%). ICA occlusion occurred in 10 (5.6%). There was no patient rebleeding during the follow-up period. A good outcome was achieved in 76.8%, with better results for unruptured aneurysms, worse results for patients with vasospasm, and with no difference according to size. Thirty-six (37.9%) patients had transient/permanent postoperative neurological deficits (25.4% ruptured vs. 62.5% unruptured aneurysms). The most frequent deficits were visual impairment and third cranial nerve palsies. Operative mortality was 11.6%, all in patients presenting with ruptured aneurysms. Despite relatively high morbidity/mortality, especially for patients with ruptured aneurysms, microsurgical treatment of paraclinoid aneurysm has high efficacy, with better outcome for unruptured aneurysms and worse outcome for patients with vasospasm.
“床突旁动脉瘤”这一术语用于描述颈内动脉（ICA）在海绵窦和后交通动脉之间的动脉瘤。由于它们在颅底的解剖关系复杂，并且通常较大/巨大，因此其手术治疗仍然是一个挑战。95 例患者（106 个动脉瘤）接受了手术治疗（1990-2010 年）。年龄为 11-72 岁。性别：74 例女性，21 例男性。随访时间为 1-192 个月（平均 51.7 个月）。86 例患者为单发，9 例为多发床突旁动脉瘤。66 个为眼动脉段，14 个位于颈内动脉上段，13 个位于下段，10 个位于内侧壁，3 个位于外侧壁。11 个为巨大动脉瘤，29 个为大型动脉瘤，66 个为小型动脉瘤。63 例为破裂性动脉瘤，32 例为未破裂性动脉瘤。2 例双侧动脉瘤患者接受了双侧入路，共进行了 97 次手术。98.2%的动脉瘤被夹闭（93.8%完全闭塞）。10 例（5.6%）发生颈内动脉闭塞。在随访期间无再出血患者。76.8%的患者获得良好结局，未破裂性动脉瘤的结果更好，血管痉挛患者的结果更差，与动脉瘤大小无关。36 例（37.9%）患者术后出现短暂/永久性神经功能缺损（破裂性动脉瘤 25.4%，未破裂性动脉瘤 62.5%）。最常见的神经功能缺损为视力障碍和第三颅神经麻痹。手术死亡率为 11.6%，均发生于破裂性动脉瘤患者。尽管存在较高的发病率/死亡率，尤其是对于破裂性动脉瘤患者，但床突旁动脉瘤的显微手术治疗具有较高的疗效，未破裂性动脉瘤的结局更好，血管痉挛患者的结局更差。
