Wang Fuyu, Sun Zhenghui, Xu Bainan, Wu Chen, Jiang Jinli, Jiang Yan, Xue Zhe, Peng Dingwei
Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China. Email:
Zhonghua Wai Ke Za Zhi. 2014 Apr;52(4):276-9.
To evaluate the management and outcomes in patients with giant symptomatic cavernous sinus aneurysms who underwent aneurysms trapping with bypass, proximal carotid occlusion and aneurysms trapping.
Twenty-three patients with giant symptomatic cavernous sinus aneurysms underwent surgery between February 2007 and March 2013, 3 cases were male and 20 cases were female patients, the age of the patients ranged between 24 and 68 years, mean age was 54.7 years. The pre-operative digital subtraction angiography (DSA) and ballon occlusion test (BOT) were performed to confirm the diagnosis and identify hemodynamic reserve with carotid occlusion, and the aneurysms trapping with bypass, aneurysms trapping and proximal occlusion of the internal carotid artery were performed according to BOT results. During the surgery, the neurophysiological monitoring and the intraoperative CT perfusion were used. The follow-up by DSA or CT angiography were made.
Seventeen patients underwent aneurysms trapping with bypass, 1 underwent aneurysms trapping and 5 underwent proximal occlusion of the internal carotid artery. After surgery, symptom improved in 4 cases, did not change in 10 cases, and new neural function deficit developed in 9 cases. The follow-up period were 3 months to 75 months. Two patients were lost. The Glasgow Outcome Scale of last follow-up were 5 in 19 patients, 3 in 1 patient and 1 in 1 patient.
The aneurysms trapping with bypass and proximal occlusion of the internal carotid artery are effective and reliable procedure for treatment of giant symptomatic cavernous sinus aneurysms in selected patients after evaluation of the pre-operative BOT, intra-operative neurophysiological monitoring and the intraoperative CT perfusion.
评估接受动脉瘤夹闭并搭桥、颈内动脉近端闭塞及动脉瘤夹闭术治疗的巨大症状性海绵窦动脉瘤患者的治疗情况及预后。
2007年2月至2013年3月期间，23例巨大症状性海绵窦动脉瘤患者接受了手术，其中男性3例，女性20例，患者年龄在24至68岁之间，平均年龄为54.7岁。术前行数字减影血管造影（DSA）和球囊闭塞试验（BOT）以确诊并确定颈动脉闭塞时的血流动力学储备，根据BOT结果进行动脉瘤夹闭并搭桥、动脉瘤夹闭及颈内动脉近端闭塞术。手术过程中，采用神经生理监测和术中CT灌注检查。术后通过DSA或CT血管造影进行随访。
17例患者接受了动脉瘤夹闭并搭桥术，1例接受了动脉瘤夹闭术，5例接受了颈内动脉近端闭塞术。术后，4例症状改善，10例无变化，9例出现新的神经功能缺损。随访时间为3个月至75个月。2例患者失访。末次随访时，19例患者的格拉斯哥预后评分（GOS）为5分，1例为3分，1例为1分。
对于经术前BOT评估、术中神经生理监测及术中CT灌注检查筛选出的合适患者，动脉瘤夹闭并搭桥及颈内动脉近端闭塞术是治疗巨大症状性海绵窦动脉瘤的有效且可靠的方法。
