Nakajima Hideki, Shimizu Shigetoshi, Tsuchiya Takuro, Suzuki Hidenori
Department of Neurosurgery, Suzuka General Hospital, Suzuka, Mie, Japan.
Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
NMC Case Rep J. 2023 Feb 23;10:33-39. doi: 10.2176/jns-nmc.2022-0272. eCollection 2023.
Blood blister aneurysms (BBAs) or pseudoaneurysms (PAs) in the internal carotid artery (ICA) have fragile necks; therefore, conventional neck clipping is difficult. The standard treatment for BBAs or PAs is trapping with high or low flow bypass. However, there is no consensus on whether or not anterior clinoidectomy should be performed together. Two patients with ruptured ICA PA (anterior protrusion) or BBA (posterior protrusion) were presented to our hospital. Complete trapping was safely performed for both types of aneurysms extradural anterior clinoidectomy and the extradural approach with dural incision. The advantages of the procedure are 1) safe proximal clipping, 2) early identification of the ICA C3 portion, 3) minimized frontal lobe retraction, 4) optic canal opening to allow mobility of the optic nerve, and 5) dural ring incision to allow mobility of the ICA.
颈内动脉（ICA）的血泡样动脉瘤（BBAs）或假性动脉瘤（PAs）具有脆弱的瘤颈；因此，传统的瘤颈夹闭术很困难。BBAs或PAs的标准治疗方法是采用高流量或低流量搭桥进行包裹。然而，对于是否应同时进行前床突切除术尚无共识。我院收治了2例ICA PA（向前突出）或BBA（向后突出）破裂的患者。通过硬膜外前床突切除术和硬膜切开的硬膜外入路，对这两种类型的动脉瘤均安全地完成了完全包裹。该手术的优点包括：1）近端夹闭安全；2）能早期识别ICA的C3段；3）额叶牵拉最小化；4）打开视神经管以使视神经能够活动；5）切开硬膜环以使ICA能够活动。
