Zeeshan Qazi, Ghodke Basavaraj V, Juric-Sekhar Gordana, Barber Jason K, Kim Louis J, Sekhar Laligam N
Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
Department of Radiology, University of Washington, Seattle, Washington, USA.
Neurol India. 2018 Nov-Dec;66(6):1741-1757. doi: 10.4103/0028-3886.246291.
Results of and the complications encountered during surgery for very large and giant intracranial aneurysms are illustrated.
To analyze a consecutive series of patients with very large and giant aneurysms treated with microsurgery.
This retrospective study included seventy six very large and giant aneurysms which were managed by clipping and bypass technique. Sixty two (82%) aneurysms were located in anterior circulation, and 14 (18%) aneurysms were located in posterior circulation. The bypasses performed included local bypasses, extra-intracranial bypasses, double bypasses and combination techniques of external carotid-internal carotid (EC-IC) bypass and local bypasses.
73 patients with 76 aneurysms were treated over 13 years. There were 44 very large and 32 giant aneurysms. Twenty-four patients presented with subarachnoid hemorrhage [SAH] (32%) while forty nine patients with 52 aneurysms (68%) were unruptured. These 73 patients underwent 63 bypass procedures with aneurysm occlusion and 13 clipping procedures. Out of 62 anterior circulation aneurysms, bypass surgery was performed in 49 patients while 13 underwent clipping. In posterior circulation aneurysms, all patients were treated with bypass procedures with proximal occlusion or trapping. In the ruptured group, 16 (67%) patients had postoperative modified Rankin Scale (mRs) 0-2, six patients (25%) had mRs 3-5, and two patients (8.4%) died. In the unruptured group, 45 patients (87%) had mRs 0-2, 3 patients (6%) had mRs 3-5, and four patients (7.6%) died.
In this large series of very large and giant aneurysms treated with microsurgical clipping and bypasses, excellent results were obtained in the long term, in regards to aneurysm occlusion, functional status, and graft patency. Our experience will be very useful to other neurosurgeons who treat these complex lesions.
阐述了大型和巨大型颅内动脉瘤手术的结果及术中遇到的并发症。
分析一系列采用显微手术治疗的大型和巨大型动脉瘤患者情况。
这项回顾性研究纳入了76例采用夹闭和搭桥技术治疗的大型和巨大型动脉瘤。62例（82%）动脉瘤位于前循环，14例（18%）动脉瘤位于后循环。所施行的搭桥手术包括局部搭桥、颅外-颅内搭桥、双搭桥以及颈外-颈内（EC-IC）搭桥与局部搭桥的联合技术。
13年间对73例患有76个动脉瘤的患者进行了治疗。其中有44个大型动脉瘤和32个巨大型动脉瘤。24例患者出现蛛网膜下腔出血[SAH]（32%），而49例患有52个动脉瘤的患者（68%）未破裂。这73例患者接受了63次动脉瘤闭塞搭桥手术和13次夹闭手术。在62个前循环动脉瘤中，49例患者接受了搭桥手术，13例接受了夹闭手术。在后循环动脉瘤患者中，所有患者均接受了近端闭塞或包裹的搭桥手术。在破裂组中，16例（67%）患者术后改良Rankin量表（mRs）评分为0 - 2分，6例患者（25%）评分为3 - 5分，2例患者（8.4%）死亡。在未破裂组中，45例患者（87%）mRs评分为0 - 2分，3例患者（6%）评分为3 - 5分，4例患者（7.6%）死亡。
在这一系列采用显微手术夹闭和搭桥治疗的大型和巨大型动脉瘤中，从动脉瘤闭塞、功能状态和移植血管通畅性方面来看，长期效果良好。我们的经验对其他治疗这些复杂病变的神经外科医生将非常有用。
