Lin T, Fox A J, Drake C G
Department of Diagnostic Radiology (Neuroradiology), University Hospital, University of Western Ontario, London, Canada.
J Neurosurg. 1989 Apr;70(4):556-60. doi: 10.3171/jns.1989.70.4.0556.
It is recognized that incomplete treatment of an aneurysm may result in recurrent hemorrhage with serious or fatal consequences. For this reason, patients treated at the authors' institution in whom a large portion of the aneurysm neck or sac remained after application of a clip or ligature have been subjected to reoperation. However, 1- to 2-mm residual necks seen in postoperative angiography have been thought to pose little risk. Some cases of aneurysms recurring from a narrow residual neck after clipping have been reported, and a few instances of recurrent aneurysm have been described after apparently complete occlusion of the neck (as observed angiographically or in the surgeon's judgment). In recent years, a surprising number of cases have been presented in which this seemingly unimportant remnant of the neck dilated over a long period to become a dangerous aneurysm. This finding stresses the importance of complete aneurysm occlusion and of postoperative angiography for the recognition of a residual aneurysm neck. This should be important not only in aneurysm clipping but also in the endovascular treatment of intracranial aneurysms with detachable balloons.
人们认识到，动脉瘤治疗不彻底可能导致复发性出血，产生严重或致命后果。因此，在作者所在机构接受治疗的患者中，若在应用夹子或结扎后仍有大部分动脉瘤颈部或瘤囊残留，则需再次手术。然而，术后血管造影显示有1至2毫米的残余颈部被认为风险较小。已有一些关于夹闭术后狭窄残余颈部复发动脉瘤的病例报道，也有少数病例描述了在颈部明显完全闭塞后（血管造影观察或外科医生判断）出现复发性动脉瘤。近年来，出现了数量惊人的病例，其中这种看似不重要的颈部残余在很长一段时间内扩张，变成了危险的动脉瘤。这一发现强调了完全闭塞动脉瘤以及术后血管造影以识别残余动脉瘤颈部的重要性。这不仅在动脉瘤夹闭术中很重要，在使用可脱性球囊对颅内动脉瘤进行血管内治疗时也很重要。
