Bavinzski G, Killer M, Ferraz-Leite H, Gruber A, Gross C E, Richling B
Department of Neurosurgery, University of Vienna Medical School, Austria.
AJNR Am J Neuroradiol. 1998 Mar;19(3):559-65.
We report our experience with 42 patients with 48 cavernous carotid aneurysms, of whom 32 were treated with endovascular techniques and 10 were managed conservatively.
The 48 aneurysms were divided into two subgroups by location: 23 were at the C-3 portion of the carotid artery (small, saccular aneurysms with an epidural, partly intracavernous location) and 25 originated at the C4-5 segment (large or giant often fusiform aneurysms with a true intracavernous location). Morphologic features in both groups correlated well with differences in clinical presentation and also influenced therapy. Sixteen of the 25 C4-5 aneurysms (all large or giant) were treated by balloon occlusion of the parent artery, four (with narrow necks) were treated with Guglielmi detachable coils (GDCs), and five were not treated (asymptomatic or minimally symptomatic). Twelve of 13 C-3 aneurysms were treated with GDCs. Ten C-3 aneurysms were not treated.
Ophthalmoplegia resolved or improved in nine of 12 patients treated with parent artery occlusion. All aneurysms treated by carotid occlusion thrombosed. Twelve of the 17 aneurysms treated with GDCs were 100% filled by the coils, four were 80% to 95% filled, and one was only 40% filled. Seven of the 100% filled aneurysms remained completely occluded, two showed slight coil compaction, and in three, follow-up angiography was not available. Among the incompletely filled aneurysms, two remained unchanged, one showed progressive thrombosis, a fourth revealed coil compaction, and in one, follow-up angiography was not available. One thromboembolic stroke and three transient ischemic attacks occurred perioperatively, for a permanent morbidity of 3.5% and a transient morbidity of 9%. There was no mortality. Mean clinical follow-up was 33 months; mean angiographic follow-up of patients treated with GDCs was 11 months.
Surgically difficult cavernous aneurysms can be obliterated by embolization with excellent clinical results. Detachable coils have become an important endovascular tool, especially for narrow-necked cavernous aneurysms of the C-3 segment, which can be protected against rupture in the subarachnoid space in most cases.
我们报告了42例患有48个海绵窦段颈动脉瘤患者的治疗经验，其中32例采用血管内技术治疗，10例采用保守治疗。
48个动脉瘤按位置分为两个亚组：23个位于颈动脉C-3段（小的囊状动脉瘤，位于硬膜外，部分位于海绵窦内），25个起源于C4-5段（大的或巨大的，常为梭形动脉瘤，真正位于海绵窦内）。两组的形态学特征与临床表现的差异密切相关，也影响治疗。25个C4-5段动脉瘤中的16个（均为大的或巨大的）采用球囊闭塞载瘤动脉治疗，4个（颈部狭窄）采用 Guglielmi 可脱性弹簧圈（GDC）治疗，5个未治疗（无症状或症状轻微）。13个C-3段动脉瘤中的12个采用GDC治疗。10个C-3段动脉瘤未治疗。
12例采用载瘤动脉闭塞治疗的患者中，9例动眼神经麻痹得到缓解或改善。所有采用颈动脉闭塞治疗的动脉瘤均形成血栓。17个采用GDC治疗的动脉瘤中，12个被弹簧圈完全填充，4个被填充80%至95%，1个仅被填充40%。12个被完全填充的动脉瘤中，7个保持完全闭塞，2个显示弹簧圈轻度压缩，3个未进行随访血管造影。在未完全填充的动脉瘤中，2个保持不变，1个显示血栓形成进展，第4个显示弹簧圈压缩，1个未进行随访血管造影。围手术期发生1例血栓栓塞性卒中，3例短暂性脑缺血发作，永久性致残率为3.5%，短暂性致残率为9%。无死亡病例。平均临床随访33个月；采用GDC治疗患者的平均血管造影随访时间为11个月。
手术困难的海绵窦段动脉瘤可通过栓塞治愈，临床效果良好。可脱性弹簧圈已成为一种重要的血管内治疗工具，尤其对于C-3段颈部狭窄的海绵窦段动脉瘤，在大多数情况下可防止其在蛛网膜下腔破裂。
