Pavesi Giacomo, Dimitriadis Stavros, Baroni Stefano, Vallone Stefano, Valzania Franco, Costella Giovanni Battista, Feletti Alberto
Department of Neurosurgery, NOCSAE Modena Hospital, Modena, Italy.
Department of Anesthesiology, NOCSAE Modena Hospital, Modena, Italy.
World Neurosurg. 2015 Aug;84(2):592.e15-21. doi: 10.1016/j.wneu.2015.03.014. Epub 2015 Mar 17.
Giant serpentine aneurysms are a rare entity, which can be managed using either endovascular or surgical techniques. Although the perioperative morbidity and mortality have decreased since the development of bypass revascularization procedures, their surgical treatment is still challenging. Intraoperative functional and perfusion monitoring techniques can be precious to make better decisions and improve outcomes.
We report on the case of a giant, unruptured, partially thrombosed, serpentine middle cerebral artery aneurysm that was treated with partial endovascular coiling of intra-aneurysmal vascular channels, surgical resection of the aneurysm, and end-to-end M1-temporal M2 anastomosis.
Intraoperative continuous motor evoked potentials monitoring, flowmetry, and indocyanine-green angiography provide precise and reproducible information about cerebral function and perfusion, respectively, allowing for more rational decision making during surgery for these challenging malformations.
巨大蜿蜒状动脉瘤是一种罕见的疾病，可采用血管内或手术技术进行治疗。尽管自旁路血管重建手术发展以来围手术期发病率和死亡率有所下降，但其手术治疗仍然具有挑战性。术中功能和灌注监测技术对于做出更好的决策和改善预后可能非常宝贵。
我们报告了一例巨大、未破裂、部分血栓形成的蜿蜒状大脑中动脉瘤病例，该病例采用了动脉瘤内血管通道部分血管内栓塞、动脉瘤手术切除以及M1端与颞叶M2端端端吻合术进行治疗。
术中连续运动诱发电位监测、血流测量和吲哚菁绿血管造影分别提供了有关脑功能和灌注的精确且可重复的信息，从而在针对这些具有挑战性的畸形进行手术时能够做出更合理的决策。
