Chen Junhui, Zhang Chunlei, Li Peipei, Chen Lei, Wang Yuhai
Department of Neurosurgery, Wuxi Clinical College (101st Hospital of PLA), Anhui Medical University, Wuxi, China.
J Craniofac Surg. 2018 Jun;29(4):1042-1046. doi: 10.1097/SCS.0000000000004422.
Giant intracranial aneurysms have always been remain the most difficult cerebrovascular lesions to treat, especially for giant cavernous carotid aneurysm (CCA). The treatment of giant CCA is a greatest challenge for neurosurgeons. Surgical clipping morbidity and mortality rates are relatively high, and endovascular embolization also have a high complication. The authors reported a special 74-year-old female patient who presented with blurred vision and double vision for 3 years, a giant CCA was found by digital subtraction angiography and computed tomography angiography. In the end, the CCA was treated using high-flow external carotid artery to middle cerebral artery bypass and clipping distal of the aneurysm. This technique and treatment was successful and without ischemia and neurologic sequelae. Also, their long-term follow-up demonstrated that brain tissue perfusion was better than before. Based on the literature reviewing, this technique might be an alternative strategy for intracranial giant unruptured aneurysms, especially for not suitable for direct clipping or with a high risk for endovascular embolization.
巨大颅内动脉瘤一直是最难治疗的脑血管病变，尤其是巨大海绵窦段颈内动脉瘤（CCA）。巨大CCA的治疗对神经外科医生来说是最大的挑战。手术夹闭的发病率和死亡率相对较高，血管内栓塞也有较高的并发症。作者报告了一名74岁的特殊女性患者，她出现视力模糊和复视3年，经数字减影血管造影和计算机断层血管造影发现一个巨大CCA。最后，采用高流量颈外动脉-大脑中动脉搭桥并夹闭动脉瘤远端的方法对CCA进行了治疗。该技术和治疗取得成功，未出现缺血和神经后遗症。此外，他们的长期随访表明脑组织灌注比以前更好。基于文献回顾，该技术可能是治疗颅内巨大未破裂动脉瘤的一种替代策略，特别是对于不适合直接夹闭或血管内栓塞风险高的情况。
