Department of Neurosurgery, Huashan Hospital of Fudan University, 12 Wulumuqi zhong Road, Shanghai 200040, China.
Acta Neurochir (Wien). 2013 Aug;155(8):1481-91. doi: 10.1007/s00701-013-1751-8. Epub 2013 May 30.
Because of the diversity of aneurysm morphology, complicated arterial anatomy and hemodynamic characteristics, tailored surgical treatments are required for cases of individual complex middle cerebral artery (MCA) aneurysms.
During an 8-year period, 59 complex MCA aneurysms in 58 patients were treated microsurgically in our department. Complex aneurysms were defined as having large (10-24 mm in diameter) or giant (diameter ≥ 25 mm) size or non-saccular morphology (fusiform, dissecting or serpentine).
Direct clipping of the aneurysmal necks was achieved in eight patients, while reconstructive clipping was performed in 25 patients. Indirect aneurysm occlusion was performed in 25 cases, including trapping or resecting the aneurysm in four cases, trapping or resecting the aneurysm with extra-intracranial (EC) or intra-intracranial (IC) bypass in 21 cases and internal carotid artery (ICA) sacrifice with EC-IC bypass in one case. Forty-eight aneurysms (81.4%) were completely obliterated. Graft patency was confirmed in 20 of 21 cases (95.2%) with bypass. A recurrent aneurysm was detected in one case and a re-operation was performed. Two patients with Hunt-Hess grade IV aneurysms died during the perioperative period. Overall, 52 cases (88.1%) had good outcomes (Glasgow Outcome Scale ≥ 4) during the late follow-up period.
The surgical modality and strategy for treating complex MCA aneurysm are decided according to the morphology of the aneurysm, vascular anatomy and the hemodynamic characteristics of each case. Thus, we developed a new classification based on the angioarchitecture. Favorable outcomes can be achieved by treating complex MCA aneurysms with appropriate surgical modalities, strategies and techniques.
由于动脉瘤形态、动脉解剖和血流动力学特征的多样性，对于个体复杂大脑中动脉（MCA）动脉瘤病例，需要采用定制的手术治疗。
在 8 年期间，我们科室对 58 例 59 个复杂 MCA 动脉瘤患者进行了显微手术治疗。复杂动脉瘤定义为具有大（直径 10-24 毫米）或巨大（直径≥25 毫米）尺寸或非囊状形态（梭形、夹层或蛇形）的动脉瘤。
8 例患者直接夹闭动脉瘤颈部，25 例患者行重建夹闭。25 例患者行间接动脉瘤闭塞，其中 4 例夹闭或切除动脉瘤，21 例夹闭或切除动脉瘤并进行颅内外（EC）或颅内-颅外（IC）旁路，1 例颈内动脉（ICA）牺牲并进行 EC-IC 旁路。48 个动脉瘤（81.4%）完全闭塞。21 例旁路中有 20 例（95.2%）证实移植物通畅。1 例复发动脉瘤，再次手术。2 例 Hunt-Hess 分级 IV 级动脉瘤患者在围手术期死亡。总体而言，52 例（88.1%）在晚期随访中预后良好（格拉斯哥结局量表≥4）。
治疗复杂 MCA 动脉瘤的手术方式和策略取决于动脉瘤的形态、血管解剖和每个病例的血流动力学特征。因此，我们根据血管构筑学制定了一种新的分类。通过采用适当的手术方式、策略和技术，可实现复杂 MCA 动脉瘤的良好结局。
