Tanaka Riki, Liew Boon Seng, Sasaki Kento, Miyatani Kyosuke, Kawase Tsukasa, Yamada Yasuhiro, Kato Yoko, Horiguchi Akihiko
Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan.
Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan.
Asian J Neurosurg. 2020 Dec 21;15(4):863-869. doi: 10.4103/ajns.AJNS_289_20. eCollection 2020 Oct-Dec.
The incidence of cavernous carotid aneurysms (CCAs) of intracranial aneurysms is low. Majority of cases presented as incidental findings with benign natural progression. The most common presenting symptoms are multiple cranial neuropathies among symptomatic patients. The treatment modalities for symptomatic patients include direct surgical clipping, endovascular coil embolization, or placement of flow diverter, or indirect procedures such as occlusion of parent artery with and without revascularization techniques. The advancement in the microsurgical treatments and endovascular devices have enable a high success rate in the treatment of patients with CCAs with low morbidity and mortality rates.
To study the surgical outcomes of patients with cavernous aneurysm who underwent high-flow bypass between 2015 and 2020 in our institution.
A total of six patients in a single institution presented with CCAs who were treated with high-flow bypass surgery were included in this case-series. A single-case illustration was presented focusing on the details of surgical case management of CCA. The intraoperative middle cerebral artery (MCA) pressure monitoring during bypass surgery was also described.
All five female patients and one male patient who were diagnosed with cavernous carotid aneurysms were studied. The mean age was 68.8 years old (range: 24-84 years old) and the mean size of the aneurysm was 19.6mm (range: 9.7 - 30mm). There were successfully treated with high flow bypasses using radial artery graft without any neurological sequelae.
The surgical treatments of cavernous carotid aneurysms should be limited to experienced neurosurgeons in view of significant risk of morbidity and mortality. Endovascular procedures may be the main stay of treatments. The success shown in this case series with parent artery occlusion and bypass surgery may provide an safe alternative to the endovascular treatment.
颅内动脉瘤中海绵窦段颈内动脉瘤（CCAs）的发病率较低。大多数病例为偶然发现，其自然病程呈良性。有症状患者最常见的表现症状为多发性颅神经病变。有症状患者的治疗方式包括直接手术夹闭、血管内弹簧圈栓塞、血流导向装置置入，或间接手术，如采用或不采用血管重建技术的载瘤动脉闭塞术。显微外科治疗和血管内装置的进步使得CCAs患者的治疗成功率较高，发病率和死亡率较低。
研究2015年至2020年在我院接受高流量搭桥手术的海绵窦段动脉瘤患者的手术效果。
本病例系列纳入了一家机构中6例接受高流量搭桥手术治疗的CCAs患者。给出了一个单病例说明，重点介绍CCA手术病例管理的细节。还描述了搭桥手术期间术中大脑中动脉（MCA）压力监测情况。
对所有诊断为海绵窦段颈内动脉瘤的5例女性患者和1例男性患者进行了研究。平均年龄为68.8岁（范围：24 - 84岁），动脉瘤平均大小为19.6mm（范围：9.7 - 30mm）。使用桡动脉移植物成功进行了高流量搭桥手术，无任何神经后遗症。
鉴于海绵窦段颈内动脉瘤手术治疗存在显著的发病和死亡风险，应仅限于经验丰富的神经外科医生实施。血管内手术可能是主要的治疗手段。本病例系列中载瘤动脉闭塞和搭桥手术所显示的成功可能为血管内治疗提供一种安全的替代方案。
