Synowitz H J, Leonhard T, Unger R R, Kloppick E
Zentralbl Neurochir. 1985;46(1):11-30.
The particularities in the clinical picture, in the diagnostic regimen and in the therapeutic schedule of eleven patients with an aneurysm showing a diameter larger than 25 mm (giant aneurysm) are presented. These aneurysms become clinically manifest as space occupation, as subarachnoid haemorrhage or TIA. 3 false diagnoses in which the aneurysm was mistaken for a cerebral tumour accentuate the necessity of a complete angiographic examination. The computer tomogram yields sufficient information permitting the suspicion of an aneurysm. In 8 patients, the direct aneurysm clipping could be performed; in 2 of them an extra-intra-cranial microanastomosis was established in the same session as a preliminary intervention. The establishment of a microanastomosis was carried out in 2 other patients. After a certain time interval, a carotid ligature (A. carotis interna) in the region of the neck was established in one of these patients. As a purely symptomatic measure for the treatment of the supratentorial pressure hydrocephalus we established a ventricular-atrial drainage in a case of basilar aneurysm. Besides 1 death and 2 severe complications, very good results could be achieved in 5 patients.
本文介绍了11例直径大于25mm的动脉瘤（巨大动脉瘤）患者在临床表现、诊断方案和治疗计划方面的特殊性。这些动脉瘤临床上表现为占位性病变、蛛网膜下腔出血或短暂性脑缺血发作（TIA）。3例假性诊断中动脉瘤被误诊为脑肿瘤，这凸显了完整血管造影检查的必要性。计算机断层扫描可提供足够信息以怀疑动脉瘤。8例患者可行直接动脉瘤夹闭术；其中2例在同一次手术中作为初步干预建立了颅内外显微吻合术。另外2例患者进行了显微吻合术。在一定时间间隔后，其中1例患者在颈部区域进行了颈内动脉结扎。作为治疗幕上压力性脑积水的单纯对症措施，我们对1例基底动脉瘤患者进行了脑室-心房引流。除1例死亡和2例严重并发症外，5例患者取得了非常好的效果。
