Bavinzski G, Killer M, Knosp E, Ferraz-Leite H, Gruber A, Richling B
Department of Neurosurgery, University of Vienna, Austria.
Acta Neurochir (Wien). 1997;139(1):37-43. doi: 10.1007/BF01850866.
We present 7 cases of false intracavernous carotid artery aneurysms. Four occurred after trauma and three were caused iatrogenically. Two of the latter occurred in patients with pituitary adenomas, one after transsphenoidal microsurgery and the other after yttrium [YI90] seed implantation into the sella. The third iatrogenic aneurysm was seen shortly after transcavernous tumour surgery. In five of our seven patients massive, delayed, life-threatening epistaxis was the leading symptom. All traumatic cases were associated with immediate unilateral blindness or blurred vision and with skull base fractures. One of these had a concomitant carotid cavernous fistula. Treatment of choice of our 5 recent cases was permanent balloon occlusion of the intracavernous carotid artery at the level of the lesion. Collateral circulation was evaluated prior to definitive carotid occlusion using a balloon test occlusion. During the balloon test adequate collateral circulation was defined as symmetric angiographic filling of both hemispheres. Awake patients were neurologically examined continuously. In unconscious patients transcranial Doppler sonography, electroencephalographic and somatosensory evoked potential monitoring was used in addition. Intra-operative heparin administration was not reversed with protamin. A postoperative continuous heparin infusion was not found necessary. In our two early cases this technique was not available: In the first case we accomplished aneurysm occlusion by a surgically introduced Fogarty balloon catheter. Our second patient needed surgical trapping of the involved carotid after early unsuccessful attempts of selective aneurysm occlusion. After treatment no further epistaxis occurred. Follow-up angiography showed persistent aneurysm occlusion. The results were excellent in 5 cases and good in 1 case. One patient with bilateral lesions suffered a stroke after occlusion of the second, remaining carotid artery, despite functioning bilateral extra-intracranial bypasses. Four years later there is a mild dysphasia still present in this patient. The mean follow-up time was 75.6 months.
我们报告7例海绵窦内假性颈动脉瘤。其中4例由外伤引起，3例为医源性。后3例中的2例发生于垂体腺瘤患者，1例在经蝶窦显微手术后，另1例在蝶鞍植入钇[YI90]种子后。第3例医源性动脉瘤在经海绵窦肿瘤手术后不久发现。在我们的7例患者中，有5例以大量、延迟性、危及生命的鼻出血为主要症状。所有外伤病例均伴有即刻单侧失明或视力模糊及颅底骨折。其中1例伴有颈内动脉海绵窦瘘。我们最近的5例患者的首选治疗方法是在病变水平对海绵窦内颈内动脉进行永久性球囊闭塞。在确定颈动脉闭塞之前，使用球囊试验闭塞评估侧支循环。在球囊试验期间，充分的侧支循环定义为双侧半球血管造影对称充盈。清醒患者持续进行神经学检查。对于昏迷患者，还使用经颅多普勒超声、脑电图和体感诱发电位监测。术中未用鱼精蛋白逆转肝素给药。未发现术后需要持续输注肝素。在我们的前2例病例中，没有这种技术：第1例我们通过手术引入Fogarty球囊导管完成动脉瘤闭塞。我们的第2例患者在早期选择性动脉瘤闭塞尝试失败后，需要手术夹闭受累颈动脉。治疗后未再发生鼻出血。随访血管造影显示动脉瘤持续闭塞。5例结果为优，1例为良。1例双侧病变患者在闭塞第二条残留颈动脉后发生中风，尽管双侧颅外-颅内旁路血管功能正常。4年后，该患者仍有轻度失语。平均随访时间为75.6个月。
