El Refaee Ehab Ahmed, Baldauf Jörg, Balau Valentin, Rosenstengel Christian, Schroeder Henry
Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany.
Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2013 Dec;74 Suppl 1:e255-60. doi: 10.1055/s-0033-1349336. Epub 2013 Aug 3.
Clipping of paraclinoid internal carotid artery aneurysms related to the superior hypophyseal artery (SHA) carries risk of occlusion of this artery when originating distal to the neck of the aneurysm. Sometimes it is inevitable to sacrifice the artery to achieve total aneurysm occlusion. Otherwise a residual aneurysm would remain, which may lead to aneurysm regrowth and subsequent rupture. However, consequences of SHA sacrifice are rarely reported in the literature. In the two presented cases, the SHA was found originating distal to the neck and within the wall of the aneurysm, making the optimal clipping of the aneurysm at the neck unfeasible without trapping of the SHA. Intraoperative indocyanine green (ICG) angiography revealed a retrograde blood flow in the SHA distal to the clip in both patients, indicating some collateral circulation. No endocrinologic deficits were encountered after surgery. The vision was not affected in one patient. In the other patient, bilateral visual field defects occurred, which improved partially in the follow-up 2 months after surgery. The consequences of SHA occlusion are difficult to predict. A large variety of anatomical variations of the vascular anatomy exists. Intraoperative ICG angiography may help to estimate collateral blood flow but is not able to predict visual decline. Although final conclusions cannot be drawn from two patients, it seems that in case of multiplicity of superior hypophyseal complex, sacrifice of one even larger branch is safe. However, visual sequelae have to be taken into consideration when a single SHA has to be sacrificed for total aneurysm clipping.
与垂体上动脉（SHA）相关的蝶鞍旁颈内动脉瘤夹闭术，当动脉瘤颈部远端发出垂体上动脉时，存在该动脉闭塞的风险。有时为了实现动脉瘤完全闭塞而牺牲该动脉是不可避免的。否则会残留动脉瘤，这可能导致动脉瘤复发及随后的破裂。然而，垂体上动脉牺牲的后果在文献中鲜有报道。在这两例病例中，发现垂体上动脉起源于动脉瘤颈部远端且在动脉瘤壁内，使得在不夹闭垂体上动脉的情况下于颈部对动脉瘤进行最佳夹闭不可行。术中吲哚菁绿（ICG）血管造影显示两名患者中夹闭远端的垂体上动脉均有逆向血流，提示存在一些侧支循环。术后未出现内分泌功能缺陷。一名患者的视力未受影响。另一名患者出现双侧视野缺损，术后2个月随访时部分改善。垂体上动脉闭塞的后果难以预测。血管解剖存在多种变异。术中ICG血管造影有助于评估侧支血流，但无法预测视力下降。虽然不能从两名患者得出最终结论，但似乎在垂体上动脉复合体存在多个分支的情况下，牺牲一个甚至更大的分支是安全的。然而，为了完全夹闭动脉瘤而必须牺牲单一垂体上动脉时，必须考虑视力后遗症。
