Kono Kenichi, Shintani Aki, Okada Hideo, Tanaka Yuko, Terada Tomoaki
Department of Neurosurgery, Wakayama Rosai Hospital.
Neurol Med Chir (Tokyo). 2014;54(2):126-32. doi: 10.2176/nmc.oa2013-0013. Epub 2013 Nov 20.
Internal carotid artery (ICA) occlusion with or without a bypass surgery is the traditional treatment for cavernous sinus (CS) aneurysms with cranial nerve (CN) dysfunction. Coil embolization without stents frequently requires retreatment because of the large size of CS aneurysms. We report the mid-term results of six unruptured CS aneurysms treated with stent-assisted coil embolization (SACE). The mean age of the patients was 72 years. The mean size of the aneurysms was 19.8 mm (range: 13-26 mm). Before treatment, four patients presented with CN dysfunction and two patients had no symptoms. SACE was performed under local or general anesthesia in three patients each. Mean packing density was 29.1% and tight packing was achieved. There were no neurological complications. CN dysfunction was cured in three patients (75%) and partly resolved in one patient (25%). Transient new CN dysfunction was observed in two patients (33%). Clinical and imaging follow-up ranged from 6 to 26 months (median: 16 months). Recanalization was observed in three patients (50%; neck remnant in two patients and dome filling in one patient), but no retreatment has yet been required. No recurrence of CN dysfunction has occurred yet. In summary, SACE increases packing density and may reduce requirement of retreatment with an acceptable cure rate of CN dysfunction. SACE may be a superior treatment for coiling without stents and be an alternative treatment of ICA occlusion for selected patients, such as older patients and those who require a high-flow bypass surgery or cannot receive general anesthesia.
伴有或不伴有搭桥手术的颈内动脉（ICA）闭塞是治疗伴有颅神经（CN）功能障碍的海绵窦（CS）动脉瘤的传统方法。由于CS动脉瘤体积较大，无支架的弹簧圈栓塞术常常需要再次治疗。我们报告了6例采用支架辅助弹簧圈栓塞术（SACE）治疗的未破裂CS动脉瘤的中期结果。患者的平均年龄为72岁。动脉瘤的平均大小为19.8毫米（范围：13 - 26毫米）。治疗前，4例患者存在CN功能障碍，2例患者无症状。3例患者在局部麻醉下进行SACE，3例患者在全身麻醉下进行。平均填充密度为29.1%，实现了致密填充。无神经并发症发生。3例患者（75%）的CN功能障碍得到治愈，1例患者（25%）部分缓解。2例患者（33%）出现短暂性新的CN功能障碍。临床和影像学随访时间为6至26个月（中位数：16个月）。3例患者（50%）出现再通（2例患者颈部残留，1例患者瘤顶充盈），但尚未需要再次治疗。尚未发生CN功能障碍复发。总之，SACE提高了填充密度，可能减少再次治疗的需求，且CN功能障碍的治愈率可接受。对于无支架弹簧圈栓塞术，SACE可能是一种更优的治疗方法，对于特定患者，如老年患者以及那些需要高流量搭桥手术或无法接受全身麻醉的患者，SACE可能是ICA闭塞的替代治疗方法。
