Division of Neurosurgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Division of Neurosurgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
World Neurosurg. 2021 May;149:e549-e562. doi: 10.1016/j.wneu.2021.01.136. Epub 2021 Feb 5.
Direct visualization of the aneurysm neck and its related branches during microsurgical clipping of supraclinoid internal carotid artery (SICA) aneurysms using a standard pterional approach may be difficult, especially when aneurysms are posteriorly projected. We evaluated the efficacy and safety of an anterior temporal approach for clipping posterior-projecting SICA aneurysms.
Between December 2017 and March 2020, 26 patients with posterior-projecting SICA aneurysms who received microsurgical clipping via an anterior temporal approach were retrospectively reviewed. The percentage of complete aneurysm obliteration, intraoperative visualization, and preservation of related branches were evaluated.
Aneurysm locations were the posterior communicating artery (PCoA) (internal carotid artery [ICA]-PCoA) in 22 patients (84.6%), the anterior choroidal artery (AChA) (ICA-AChA) in 3 patients (11.5%), and both locations in 1 patient (3.9%). Complete aneurysm obliteration was achieved in all patients. For ICA-PCoA aneurysms in which the PCoA was preoperatively identified, the artery was intraoperatively identified in all cases and preserved 100% after surgery. For ICA-AChA aneurysms, AChAs were intraoperatively identified and preserved in all cases after surgery. Procedural-related infarction was 8.7% for ICA-PCoA aneurysms and 7.7% for all SICA aneurysms. Transient oculomotor nerve palsy was found in 2 patients (7.7%). No postoperative temporal contusion was detected. A good outcome at 3 months after surgery was achieved in 90% of patients for good clinical-grade subarachnoid hemorrhage and unruptured cases.
The anterior temporal approach is safe and effective for clipping SICA aneurysms with posterior projection, with a high preservation rate of the related branches.
在经翼点入路行显微夹闭术治疗颈内动脉眼段（SICA）动脉瘤时，直接观察动脉瘤颈及其相关分支可能较为困难，尤其是当动脉瘤呈向后突出时。我们评估了经额前颞部入路夹闭后突 SICA 动脉瘤的疗效和安全性。
回顾性分析 2017 年 12 月至 2020 年 3 月间采用经额前颞部入路行显微夹闭术治疗的 26 例后突 SICA 动脉瘤患者的临床资料。评估完全闭塞动脉瘤的比例、术中可视化及相关分支的保留情况。
22 例（84.6%）患者的动脉瘤位于后交通动脉（PCoA）-颈内动脉（ICA）段（ICA-PCoA），3 例（11.5%）位于脉络膜前动脉（AChA）-ICA 段（ICA-AChA），1 例（3.9%）位于两者之间。所有患者均实现了完全闭塞动脉瘤。对于术前可识别 PCoA 的 ICA-PCoA 动脉瘤，所有患者术中均识别出该动脉，并在术后 100%保留。对于 ICA-AChA 动脉瘤，所有患者术后均能识别并保留 AChA。ICA-PCoA 动脉瘤和所有 SICA 动脉瘤的手术相关梗死发生率分别为 8.7%和 7.7%。2 例（7.7%）患者出现短暂动眼神经麻痹。术后均未发现颞叶挫伤。对于良好临床分级蛛网膜下腔出血和未破裂的病例，90%的患者在术后 3 个月获得了良好的转归。
经额前颞部入路治疗后突 SICA 动脉瘤安全有效，相关分支保留率高。
