Kim Louis J, Tariq Farzana, Levitt Michael, Barber Jason, Ghodke Basavaraj, Hallam Danial K, Sekhar Laligam N
*Department of Neurological Surgery; and ‡Department of Radiology, University of Washington, Seattle, Washington.
Neurosurgery. 2014 Jan;74(1):51-61; discussion 61; quiz 61. doi: 10.1227/NEU.0000000000000192.
Unruptured aneurysms of the cavernous and paraclinoid internal carotid artery can be approached via microsurgical and endovascular approaches. Trends in treatment reflect a steady shift toward endovascular techniques.
To analyze our results with multimodal treatment.
We reviewed patients with unruptured cavernous and paraclinoid internal carotid artery aneurysms proximal to the posterior communicating artery treated at a single center from 2007 to 2012. Treatment included 4 groups: (1) stent-assisted coiling, (2) pipeline endovascular device (PED) flow diverter, (3) clipping, and (4) trapping/bypass. Follow-up was 2 to 60 months.
The 109 aneurysms in 102 patients were studied with the following treatment groupings: 41 were done with stent-assisted coiling, 24 with Pipeline endovascular device, 24 by microsurgical clipping, and 20 by trap/bypass. Group: (1) two percent had delayed significant intraparenchymal hemorrhage; (2) thirteen percent had central nerve palsies, 8% had small asymptomatic infarcts, and 4% had small, asymptomatic remote-site hemorrhages; (3) twenty-nine percent of patients suffered from transient central nerve palsies, 4% experienced major stroke, and 8% had small intracerebral hemorrhages; (4) thirty-five percent had transient central nerve palsies, 10% had strokes, and 10% had intracerebral hemorrhages. In terms of follow-up obliteration, 83% had complete/nearly complete obliteration at last follow-up, 17% had residual aneurysms, and 10% required retreatment. Ninety-six percent of group 1 (35/38), 100% of group 2 (23/23), 100% of group 3 (21/21), and 95% of group 4 had modified Rankin Scale scores of 0 to 1.
Treatment of these aneurysms can be carried out with acceptable rates of morbidity. Careful patient selection is crucial for optimal outcome. Endovascular treatment volumes likely will continue to predominate over microsurgical techniques as changing skill sets evolve in neurosurgery, but individualized application of all available treatment options will continue.
海绵窦段及床突旁颈内动脉未破裂动脉瘤可通过显微外科和血管内治疗方法进行处理。治疗趋势显示正稳步向血管内技术转变。
分析我们采用多模式治疗的结果。
我们回顾了2007年至2012年在单一中心接受治疗的后交通动脉近端海绵窦段及床突旁颈内动脉未破裂动脉瘤患者。治疗包括4组：（1）支架辅助弹簧圈栓塞；（2）Pipeline血管内装置（PED）血流导向装置；（3）夹闭术；（4）孤立/搭桥术。随访时间为2至60个月。
对102例患者的109个动脉瘤进行了研究，治疗分组如下：41例行支架辅助弹簧圈栓塞，24例行Pipeline血管内装置治疗，24例行显微外科夹闭术，20例行孤立/搭桥术。组：（1）2%发生延迟性明显脑实质内出血；（2）13%发生中枢神经麻痹，8%有小的无症状梗死，4%有小的无症状远处出血；（3）29%的患者出现短暂性中枢神经麻痹，4%发生严重卒中，8%有小的脑内出血；（4）35%有短暂性中枢神经麻痹，10%发生卒中，10%有脑内出血。在随访闭塞情况方面，83%在末次随访时达到完全/近乎完全闭塞，17%有残留动脉瘤，10%需要再次治疗。第1组96%（35/38）、第2组100%（23/23）、第3组100%（21/21）和第4组95%的改良Rankin量表评分为0至1分。
这些动脉瘤的治疗可以在可接受的发病率下进行。仔细选择患者对于获得最佳结果至关重要。随着神经外科技术的不断发展，血管内治疗量可能会继续超过显微外科技术，但所有可用治疗方案的个体化应用仍将继续。
