Lawton M T, Spetzler R F
Barrow Neurological Institute, Phoenix, Arizona, USA.
Clin Neurosurg. 1995;42:245-66.
Patients with untreated giant intracranial aneurysms have a dismal prognosis as a result of hemorrhage, cerebral compression, and thromboembolism. Therefore, giant aneurysms should be treated. The operative approach is chosen to maximize exposure of the aneurysm. Direct clipping of the aneurysm neck, with preservation of the parent and branch vessels, is the preferred method of occlusion. Hypothermic circulatory arrest may facilitate clipping in selected patients. Alternative techniques for unclippable aneurysms can be utilized, but they compromise parent arteries and require revascularization to maintain CBF. Because mass effect is an important cause of patient morbidity, giant aneurysms are usually debulked after they have been eliminated completely from the circulation. Giant aneurysms are complex lesions that demand thorough surgical planning, individualized strategies, and a multidisciplinary effort.
未经治疗的巨大颅内动脉瘤患者由于出血、脑压迫和血栓栓塞，预后很差。因此，巨大动脉瘤应予以治疗。选择手术入路以最大程度地暴露动脉瘤。在保留载瘤动脉和分支血管的情况下直接夹闭动脉瘤颈部是首选的闭塞方法。低温循环停止可能有助于某些特定患者的夹闭操作。对于无法夹闭的动脉瘤，可以采用其他技术，但这些技术会损害载瘤动脉，需要进行血管重建以维持脑血流量。由于占位效应是患者发病的重要原因，巨大动脉瘤在完全从循环中消除后通常要进行减容。巨大动脉瘤是复杂病变，需要全面的手术规划、个体化策略和多学科协作。
