经颈总动脉直接穿刺逆行抽吸减压治疗鞍旁动脉瘤

Retrograde Suction Decompression Through Direct Puncture of the Common Carotid Artery for Paraclinoid Aneurysm.

作者信息

Otani Naoki, Wada Kojiro, Toyooka Terushige, Fujii Kazuya, Ueno Hideaki, Tomura Satoshi, Tomiyama Arata, Nakao Yasuaki, Yamamoto Takuji, Mori Kentaro

机构信息

Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 59-8513, Japan.

Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan.

出版信息

Acta Neurochir Suppl. 2016;123:51-6. doi: 10.1007/978-3-319-29887-0_7.

DOI:10.1007/978-3-319-29887-0_7

PMID:27637628

Abstract

BACKGROUND

Surgical clipping of paraclinoid aneurysm can be very difficult because strong adhesions may hinder the dissection of the perforators and surrounding anatomical structures from the aneurysm dome. We describe our experience with using retrograde suction decompression during the clipping of paraclinoid aneurysms and discuss the relative advantages and pitfalls.

MATERIALS AND METHODS

This study included 23 patients with large and giant paraclinoid aneurysms who underwent surgical treatment consisting of direct clipping with suction decompression between March 2004 and August 2014. Direct puncture of the common carotid artery (CCA) was performed with a 20-gauge needle. The aneurysm was temporarily trapped by clamping of the CCA and external carotid artery (ECA), followed by temporary clipping of the intracranial internal carotid artery (ICA) distal to the aneurysm neck. Blood was then gently aspirated through a catheter introduced into the cervical ICA, resulting in collapse of the aneurysm. Therefore, safe aneurysm dissection was feasible during interruption of the blood flow, which could be maintained for up to 5 min. This procedure was repeated until dissection and clipping of the aneurysm were completed.

RESULTS

Seven patients were admitted with SAH, 11 with asymptomatic unruptured aneurysm, and 5 with symptomatic unruptured aneurysm. The aneurysms were located on the paraclinoidal segment of the ICA in 15 cases, on the ICA-posterior communicating artery (PComA) in 6, at the ICA bifurcation in 1, and on the anterior wall of the ICA in 1. None of them suffered complications related to the CCA puncture. Surgical outcome was good recovery in 13 patients, moderate disability in 4, severe disability in 4, and vegetative state in 1.

CONCLUSION

Retrograde suction decompression through direct puncture of the common carotid artery is a useful adjunct technique for the clipping of paraclinoid ICA aneurysms.

摘要

背景

床突旁动脉瘤的手术夹闭可能非常困难，因为紧密粘连可能会妨碍从动脉瘤瘤顶分离穿支血管和周围解剖结构。我们描述了在床突旁动脉瘤夹闭过程中使用逆行吸引减压的经验，并讨论了其相对优势和陷阱。

材料与方法

本研究纳入了23例大型和巨大型床突旁动脉瘤患者，他们在2004年3月至2014年8月期间接受了包括直接夹闭并吸引减压的手术治疗。用20号针头直接穿刺颈总动脉（CCA）。通过夹闭CCA和颈外动脉（ECA）暂时阻断动脉瘤血流，随后在动脉瘤颈远端临时夹闭颅内颈内动脉（ICA）。然后通过插入颈段ICA的导管轻轻抽吸血液，使动脉瘤塌陷。因此，在血流中断期间进行安全的动脉瘤分离是可行的，血流中断时间最长可达5分钟。重复该操作直至完成动脉瘤的分离和夹闭。

结果

7例患者因蛛网膜下腔出血（SAH）入院，11例为无症状未破裂动脉瘤，5例为有症状未破裂动脉瘤。动脉瘤位于ICA床突段15例，位于ICA-后交通动脉（PComA）6例，位于ICA分叉处1例，位于ICA前壁1例。所有患者均未发生与CCA穿刺相关的并发症。手术结果为13例患者恢复良好，4例中度残疾，4例重度残疾，1例植物状态。