Wu Chen, Sun Zhenghui, Wang Jun, Li Baomin, Xu Bainan, Zhou Dingbiao
Department of Neurosurgery, General Hospital of People's Liberation Army, Beijing 100853, China.
Department of Neurosurgery, General Hospital of People's Liberation Army, Beijing 100853, China. Email:
Zhonghua Wai Ke Za Zhi. 2014 Jan;52(1):30-4.
To study the clinical characteristics, surgical principles and treatment options of blood-blister-like cerebral aneurysms in supra-clinoid segment of internal carotid artery.
Twelve blood-blister-like aneurysms were retrospectively studied including 4 open-surgery cases and 8 endovascular-treated cases from November 2008 to December 2012. Patients comprised 8 female and 4 male patients, whose mean age was 46.6 (range 38-56) years. Eleven patients presented with severe headache as the primary symptom, and 1 patient was found with aneurysm incidentally. Preoperative Hunt-Hess graded 0 in 1 patient, graded I in 5 patients, graded II in 4 patients, and graded III in 2 patients. By DSA examinations, 4 blood-blister-like aneurysms located in anterior wall and 8 in medial-anterior wall of supra-clinoid segment of internal carotid artery. Open surgical treatment included direct clipping, trapping, or wrapping and interventional treatment included stent-assisted coiling or simple stent placement. Intra-operative electroencephalogram and somatosensory evoked potentials monitoring was regularly used. Microvascular Doppler ultrasonography and indocyanine green videoangiography were used to assess blood flow in parent and branch vessels. The patients were followed up at 6 months by CT angiography (CTA) examination in outpatient clinic.
For 4 open surgeries, 2 aneurysms were directly clipped, 1 was trapped and 1 was wrapped. The patient underwent trapping paralyzed postoperatively. For endovascular treatment, 6 patients were coiled assisted with stents and 2 patients were treated with simple stent placement. All the patients were followed with a mean follow-up time of 16 months (range, 6-61 months). At 6 months follow-up, 3 out of 4 surgical treated patients had good outcome and 1 was moderately severe disabled by modified Rankin scale; 1 patient underwent wrapping recurred and was transferred to endovascular treatment. Of the 6 patients treated with stent-assisted coiling, 4 patients were recurrent and coil replacements were performed. Two patients with simple stent placement had no recurrences.
Blood-blister-like aneurysm is a special type of complex cerebral aneurysm. Comprehensive understanding of blood-blister-like aneurysm is the key to successful treatment.Open surgery is difficult procedure with high risk and complications while stent-assisted coiling has a high recurrent rate. To date, neither is the safe and effective treatment option.
探讨颈内动脉床突上段血泡样脑动脉瘤的临床特点、手术原则及治疗方法。
回顾性分析2008年11月至2012年12月收治的12例血泡样动脉瘤患者，其中4例行开颅手术，8例行血管内治疗。患者中女性8例，男性4例，平均年龄46.6岁（38 - 56岁）。11例以剧烈头痛为主要症状，1例为偶然发现。术前Hunt-Hess分级：0级1例，Ⅰ级5例，Ⅱ级4例，Ⅲ级2例。DSA检查显示，4例血泡样动脉瘤位于颈内动脉床突上段前壁，8例位于颈内动脉床突上段内侧前壁。开颅手术方式包括直接夹闭、包裹或孤立术，血管内治疗包括支架辅助弹簧圈栓塞或单纯支架置入术。术中常规应用脑电图和体感诱发电位监测。应用微血管多普勒超声和吲哚菁绿血管造影评估载瘤动脉及分支血管血流情况。术后6个月门诊行CT血管造影（CTA）随访。
4例开颅手术患者中，2例行直接夹闭，1例行孤立术，1例行包裹术。行孤立术的患者术后出现偏瘫。血管内治疗患者中，6例行支架辅助弹簧圈栓塞，2例行单纯支架置入术。所有患者均获随访，平均随访时间16个月（6 - 61个月）。术后6个月随访，4例手术治疗患者中3例预后良好，1例按改良Rankin量表评定为中度残疾；1例行包裹术的患者复发，改行血管内治疗。6例行支架辅助弹簧圈栓塞的患者中，4例复发并再次行弹簧圈置换术。2例行单纯支架置入术的患者未复发。
血泡样动脉瘤是一种特殊类型的复杂脑动脉瘤。全面了解血泡样动脉瘤是治疗成功的关键。开颅手术操作困难、风险高且并发症多，而支架辅助弹簧圈栓塞复发率高。目前尚无安全有效的治疗方法。
