Lin Hung-Lin, Chen Wei-Liang, Chen Chun-Chung, Guo Jeng-Hung, Liu Yu-Fang, Cho Der-Yang, Tu Chih-Hsiu
Department of Neurosurgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan.
Department of Neuroradiology, China Medical University Hospital, China Medical University, Taichung City, Taiwan.
World Neurosurg. 2024 Nov;191:e167-e175. doi: 10.1016/j.wneu.2024.08.092. Epub 2024 Sep 7.
To evaluate the effects of a multimodal management technique combining surgical muscle wrapping, clipping, and flow-diverter stent (FDS) placement in patients with ruptured blood blister-like aneurysms (BBAs) in the internal carotid artery (ICA).
In a retrospective case series review from 2020 to 2023, 3 patients with ruptured ICA BBAs underwent multimodal management, an approach combining muscle wrapping, surgical clipping, and FDS embolization. The aneurysm sac was initially packed and wrapped with multiple tailored temporalis muscle grafts and then secured using fenestration clips, with good preservation of the ICA branches. The FDS was placed 2-3 weeks after the clipping.
All 3 patients had right ICA BBAs (mean age, 52 years). The modified Hunt and Hess grades ranged from 2 to 3, and the Fisher grades ranged from 3 to 4. The mean angiography follow-up time was 27.7 months (15, 31, and 37 months). There were no instances of symptomatic vasospasm or visible ischemic stroke during follow-up computed tomography. No patient required cerebrospinal fluid shunt implantation, and all achieved favorable neurological outcomes (modified Rankin scale 0-1). Follow-up digital subtraction angiography revealed no evidence of aneurysm recurrence or significant ICA stenosis.
We discuss a promising multimodal management approach for ruptured ICA BBAs combining muscle wrapping, surgical clipping, and FDS embolization. This technique was safe and effective in preventing re-rupture, achieving positive short-term clinical outcomes. Further research and more extensive studies are required to validate the long-term efficacy of this approach.
评估手术肌肉包裹、夹闭和血流导向支架（FDS）置入相结合的多模式管理技术对颈内动脉（ICA）血泡样动脉瘤（BBA）破裂患者的疗效。
在一项2020年至2023年的回顾性病例系列研究中，3例ICA BBA破裂患者接受了多模式管理，即肌肉包裹、手术夹闭和FDS栓塞相结合的方法。首先用多个定制的颞肌移植物填充并包裹动脉瘤囊，然后使用开窗夹固定，同时很好地保留了ICA分支。夹闭术后2 - 3周放置FDS。
所有3例患者均为右侧ICA BBA（平均年龄52岁）。改良Hunt和Hess分级为2至3级，Fisher分级为3至4级。血管造影平均随访时间为27.7个月（15、31和37个月）。在随访计算机断层扫描期间，没有出现症状性血管痉挛或可见的缺血性卒中病例。没有患者需要植入脑脊液分流器，所有患者均获得了良好的神经功能结局（改良Rankin量表评分为0 - 1）。随访数字减影血管造影显示没有动脉瘤复发或ICA明显狭窄的证据。
我们讨论了一种有前景的多模式管理方法，用于治疗破裂的ICA BBA，该方法结合了肌肉包裹、手术夹闭和FDS栓塞。该技术在预防再破裂方面安全有效，取得了良好的短期临床效果。需要进一步研究和更广泛的研究来验证该方法的长期疗效。
