Nurminen Ville, Kivipelto Leena, Kivisaari Riku, Niemelä Mika, Lehecka Martin
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
World Neurosurg. 2019 Jun;126:e453-e462. doi: 10.1016/j.wneu.2019.02.072. Epub 2019 Feb 28.
Bypass surgery is a special technique used to treat complex internal carotid artery (ICA) aneurysms. The aim of this retrospective study is to provide a comprehensive description of treatment and outcome of complex ICA aneurysms at different ICA segments (cavernous, supraclinoid, ICA bifurcation) treated with bypass procedures.
We identified 39 consecutive patients with 41 complex ICA aneurysms that were treated with 44 bypass procedures between 1998 and 2016. We divided the aneurysms into 3 anatomic subgroups to review our treatment strategy. All the imaging studies and medical records were reviewed for relevant information.
The aneurysm occlusion (n = 34, 83%) or flow modification (n = 5, 12%) was achieved in 39 aneurysms (95%). The long-term bypass patency rate was 68% (n = 30). Minor postoperative ischemia or hemorrhage was commonly seen (n = 20, 51%), but large-scale strokes were rare (n = 1, 3%). Preoperative dysfunction of extraocular muscles (cranial nerves III, IV, and VI) showed low-to-moderate improvement rates (20%-50%). Preoperative vision disturbance (cranial nerve II) improved seldom (22%). At the latest follow-up (mean; 51 months) 29 patients (74%) were independent (modified Rankin Scale ≤2).
Bypass surgery for complex ICA aneurysms is a feasible treatment method with an acceptable risk profile. Patients should be informed of the uncertainty related to improvement of pretreatment cranial nerve dysfunctions.
搭桥手术是一种用于治疗复杂颈内动脉（ICA）动脉瘤的特殊技术。本回顾性研究的目的是全面描述采用搭桥手术治疗不同ICA节段（海绵窦段、床突上段、ICA分叉处）复杂ICA动脉瘤的治疗方法及结果。
我们确定了1998年至2016年间连续39例患有41个复杂ICA动脉瘤的患者，这些患者接受了44次搭桥手术。我们将动脉瘤分为3个解剖亚组以回顾我们的治疗策略。对所有影像学研究和病历进行了相关信息的回顾。
39个动脉瘤（95%）实现了动脉瘤闭塞（n = 34，83%）或血流改道（n = 5，12%）。长期搭桥通畅率为68%（n = 30）。术后常见轻微缺血或出血（n = 20，51%），但大规模卒中罕见（n = 1，3%）。术前眼外肌（Ⅲ、Ⅳ和Ⅵ脑神经）功能障碍显示改善率低至中等（20% - 50%）。术前视力障碍（Ⅱ脑神经）很少改善（22%）。在最近一次随访（平均；51个月）时，29例患者（74%）独立（改良Rankin量表≤2）。
复杂ICA动脉瘤的搭桥手术是一种可行的治疗方法，风险可接受。应告知患者与术前脑神经功能障碍改善相关的不确定性。
