Carlson Andrew P, Loveren Harry R van, Youssef A Samy, Agazzi Siviero
Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, United States ; Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States.
Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States.
J Neurol Surg B Skull Base. 2015 Mar;76(2):150-6. doi: 10.1055/s-0034-1396596. Epub 2014 Nov 26.
Objectives Despite advances in neuroimaging, it is not always definitive whether a paraclinoid aneurysm is intradural or entirely extradural. We illustrate the potential use of surgical exploration in these aneurysms that we refer to as "junctional" aneurysms. Methods Retrospective review of eight patients with unruptured aneurysms who underwent a planned surgical exploration of a junctional aneurysm. Results Of the eight patients, three underwent exploration of the aneurysm during surgery for a different aneurysm. All three of these were found to be extradural. Five patients underwent a craniotomy for the exclusive purpose of clarifying the location of the aneurysm. Two of these cases were found to be intradural and were clipped. Two cases were found to be extradural. In one patient, the initially extradural aneurysm was converted into an intradural aneurysm during removal of the anterior clinoid process, necessitating surgical clipping. One transient third nerve palsy was observed. Discussion Until further progress in neuroimaging allows clinicians to determine unequivocally the exact anatomical location of a paraclinoid aneurysm, we advocate the use of the term junctional aneurysm to reflect the clinical uncertainty inherent in management decisions made regarding these aneurysms. We have illustrated a strategy of surgical exploration in select patients.
目的 尽管神经影像学取得了进展，但对于床突旁动脉瘤是硬膜内还是完全硬膜外的，并不总是能够明确诊断。我们阐述了手术探查在这些我们称为“交界性”动脉瘤中的潜在应用。方法 回顾性分析8例未破裂动脉瘤患者，这些患者接受了计划性的交界性动脉瘤手术探查。结果 8例患者中，3例在因其他动脉瘤进行手术时对该动脉瘤进行了探查。这3例均发现为硬膜外。5例患者仅为明确动脉瘤位置而进行了开颅手术。其中2例发现为硬膜内并进行了夹闭。2例发现为硬膜外。1例患者在切除前床突过程中，最初的硬膜外动脉瘤转变为硬膜内动脉瘤，需要进行手术夹闭。观察到1例短暂性动眼神经麻痹。讨论 在神经影像学取得进一步进展，使临床医生能够明确确定床突旁动脉瘤的确切解剖位置之前，我们主张使用“交界性动脉瘤”这一术语，以反映在对这些动脉瘤进行管理决策时固有的临床不确定性。我们阐述了在特定患者中进行手术探查的策略。
