Matano Fumihiro, Tanikawa Rokuya, Kamiyama Hiroyasu, Ota Nakao, Tsuboi Toshiyuki, Noda Kosumo, Miyata Shiro, Matsukawa Hidetoshi, Murai Yasuo, Morita Akio
Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan; Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan.
World Neurosurg. 2016 Jan;85:169-76. doi: 10.1016/j.wneu.2015.08.068. Epub 2015 Sep 5.
Few reports have been published discussing surgical outcomes of paraclinoid aneurysms using multifarious treatments such as high-flow bypass.
We retrospectively analyzed findings from 127 consecutive patients (19 males, mean age at surgery: 56.8 years, range: 19-81 years) at our hospital. The size of aneurysms ranged from 2.7-43.2 mm (mean: 6.9 mm). Extradural anterior clinoidectomy was used to clip small aneurysms. As large or giant aneurysms required a longer temporal occlusion period and often could not undergo simple clipping, high-flow bypass with anterior clinoidectomy or cervical internal carotid ligation was performed to reduce aneurysm blood flow and induce thrombosis. We reviewed a postoperative modified Rankin Scale (mRS), radiographic outcomes, cerebral infarction, and visual disturbance. In addition, we analyzed factors relating to the outcomes and complications, with focus on the aneurysm size, location, and type of surgical treatment.
Good outcomes were achieved in all patients, as follows: mRS 0:100, mRS 1:16, mRS 2:11, and mRS 3-6:0. Among the 127 patients, complete exclusion of aneurysm was achieved in 119 cases (93.7%). Postoperative morbidity included ischemic lesions in 11 (8.6%) and visual disturbance in 24 (18.8%). Significant statistical differences were observed between ischemic complication and aneurysm size and location (P = 0.0001) and surgical treatment (P < 0.0001).
Surgical treatment of unruptured paraclinoid aneurysm has high efficacy with good outcomes and a high rate of complete exclusion. However, the rate of visual disturbance is relatively high. Careful surgical techniques and intraoperative monitoring are therefore required.
很少有报告讨论使用多种治疗方法（如高流量搭桥术）治疗床突旁动脉瘤的手术结果。
我们回顾性分析了我院连续127例患者（19例男性，手术平均年龄：56.8岁，范围：19 - 81岁）的资料。动脉瘤大小为2.7 - 43.2mm（平均：6.9mm）。硬膜外前床突切除术用于夹闭小型动脉瘤。由于大型或巨大型动脉瘤需要更长的临时阻断时间且通常无法进行单纯夹闭，因此采用前床突切除术联合高流量搭桥术或颈内动脉结扎术以减少动脉瘤血流并诱导血栓形成。我们评估了术后改良Rankin量表（mRS）、影像学结果、脑梗死和视觉障碍情况。此外，我们分析了与结果和并发症相关的因素，重点关注动脉瘤大小、位置和手术治疗类型。
所有患者均取得了良好的结果，具体如下：mRS 0：100例，mRS 1：16例，mRS 2：11例，mRS 3 - 6：0例。127例患者中，119例（93.7%）实现了动脉瘤的完全闭塞。术后并发症包括11例（8.6%）缺血性病变和24例（18.8%）视觉障碍。缺血性并发症与动脉瘤大小、位置以及手术治疗之间存在显著统计学差异（P = 0.0001）和（P < 0.0001）。
未破裂床突旁动脉瘤的手术治疗具有较高的疗效，结果良好且完全闭塞率高。然而，视觉障碍发生率相对较高。因此，需要谨慎的手术技术和术中监测。
