Chen Chuan, Hou Bo, Li Wen-Sheng, Guo Ying
Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
World Neurosurg. 2017 Apr;100:280-287. doi: 10.1016/j.wneu.2017.01.011. Epub 2017 Jan 16.
We summarize the treatment effectiveness and experience of 4 patients who underwent internal carotid ligation combined with low-flow bypass as a treatment for large-giant cavernous sinus segment (CS ICA) aneurysms.
Surgery-suitable patients with large-giant CS ICA aneurysms received internal carotid ligation combined with low-flow superficial temporal artery-middle cerebral artery bypass surgery. All the patients were followed up for aneurysm prognosis, anastomosis patency, and occurrences of low-flow-related ischemic complications.
Four suitable cases between 2012 and 2015 were studied. They consisted of 1 man and 3 women, with the mean age of 56.3 ± 11.9 years. Maximum and minimum aneurysm diameter were 26 mm and 20 mm, respectively, with an average of 22.3 ± 2.6 mm. During surgery, the mean blockage time of the middle cerebral artery was 19.3 ± 1.3 minutes. Postoperative computed tomography angiography examination indicated that thrombosis could be found in the aneurysm lumen. No patient was found with low-flow-related ischemic complications after surgery. The mean postoperative follow-up time was 25.0 ± 10.4 months. During the follow-up period, no patient showed low-flow-related ischemic complications or aneurysm recurrence.
For patients with large-giant CS ICA aneurysms, treatment of internal carotid ligation combined with low-flow superficial temporal artery-middle cerebral artery bypass surgery was an effective and safe surgical strategy. To improve surgery safety and for appropriate selection of surgery cases, the details, risks, and benefits associated with the surgery should be considered by the surgeon.
总结4例行颈内动脉结扎联合低流量搭桥术治疗大型-巨大型海绵窦段颈内动脉瘤患者的治疗效果及经验。
适合手术的大型-巨大型海绵窦段颈内动脉瘤患者接受颈内动脉结扎联合低流量颞浅动脉-大脑中动脉搭桥手术。对所有患者进行随访，观察动脉瘤预后、吻合口通畅情况及低流量相关缺血性并发症的发生情况。
研究了2012年至2015年期间的4例合适病例。其中男性1例，女性3例，平均年龄56.3±11.9岁。动脉瘤最大直径和最小直径分别为26 mm和20 mm，平均为22.3±2.6 mm。手术过程中，大脑中动脉平均阻断时间为19.3±1.3分钟。术后计算机断层扫描血管造影检查显示动脉瘤腔内有血栓形成。术后未发现患者有低流量相关缺血性并发症。术后平均随访时间为25.0±10.4个月。随访期间，无患者出现低流量相关缺血性并发症或动脉瘤复发。
对于大型-巨大型海绵窦段颈内动脉瘤患者，颈内动脉结扎联合低流量颞浅动脉-大脑中动脉搭桥手术是一种有效且安全的手术策略。为提高手术安全性并合理选择手术病例，外科医生应考虑该手术的细节、风险和益处。
