Lee Sung Ho, Ahn Jae Sung, Kwun Byung Duk, Park Wonhyoung, Park Jung Cheol, Roh Sung Woo
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea.
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2015 Dec;58(6):518-27. doi: 10.3340/jkns.2015.58.6.518. Epub 2015 Dec 31.
The treatment of complex intracranial aneurysms remains challenging. One approach is the application of surgical flow alteration to treat aneurysms that are neither clippable, trappable, or coilable. The efficacy and limitations of surgical flow alteration have not yet been established.
Cases of complex aneurysms treated with surgical flow alteration (proximal occlusion with or without bypass, distal occlusion with or without bypass and bypass only) were included in this retrospective study.
Among a total of 16 cases, there were 7 giant aneurysms (≥25 mm diameter) and 9 large aneurysms (>10 mm diameter); 15 of 16 aneurysms were unruptured. There were 8 aneurysms located in the anterior circulation, while the other 8 were in the posterior circulation. Aneurysms were treated with proximal occlusion in 10 cases and distal occlusion in 5 cases; in 1 case, the aneurysm occluded spontaneously after bypass without parent artery occlusion. All but 2 cases underwent prior or concurrent bypass surgery. Complete obliteration of the aneurysm at the latest imaging follow-up was shown in 12 of 16 cases (75.0%). Bypass patency was confirmed in 13 of 15 cases (86.7%). Surgery-related morbidity developed in 3 cases (18.8%, Glasgow outcome scale of 4) and all were perforator infarctions. There were no mortalities.
Surgical flow alteration resulted in a high rate of aneurysmal obliteration with acceptable morbidity. Although several limitations remained, it could represent an alternative method for treating complex aneurysms.
复杂颅内动脉瘤的治疗仍然具有挑战性。一种方法是应用手术血流改道来治疗既不能夹闭、不能包裹也不能栓塞的动脉瘤。手术血流改道的疗效和局限性尚未明确。
本回顾性研究纳入了采用手术血流改道（近端闭塞伴或不伴搭桥、远端闭塞伴或不伴搭桥以及单纯搭桥）治疗的复杂动脉瘤病例。
在总共16例病例中，有7例巨大动脉瘤（直径≥25mm）和9例大型动脉瘤（直径>10mm）；16例动脉瘤中有15例未破裂。8例动脉瘤位于前循环，另外8例位于后循环。10例采用近端闭塞治疗动脉瘤，5例采用远端闭塞治疗；1例动脉瘤在搭桥后未闭塞母动脉的情况下自行闭塞。除2例病例外，所有病例均接受了先前或同期的搭桥手术。在最新的影像学随访中，16例中有12例（75.0%）动脉瘤完全闭塞。15例中有13例（86.7%）搭桥通畅得到证实。3例（18.8%，格拉斯哥预后评分4分）发生了与手术相关的并发症，均为穿支梗死。无死亡病例。
手术血流改道导致动脉瘤闭塞率较高，且并发症可接受。尽管仍有一些局限性，但它可能是治疗复杂动脉瘤的一种替代方法。
