Krylov V V, Lebedev V V, Evzikov G Iu
Zh Vopr Neirokhir Im N N Burdenko. 1998 Apr-Jun(2):7-8.
Incidence, causes and results of permanent ICA clipping during arterial cerebral aneurysm surgery were analyzed in randomized group of 470 patients. Permanent ICA clipping was performed in 6 cases (1.3% of all surgeries). The causes of permanent ICA clipping were ICA wall rupture in 4 (0.9%) cases, bleeding from aneurysms of the ophthalmic segment of the internal carotid artery (ICA) in 2 (0.4%). Atherosclerotic changes of ICA were found and verified by biopsy in all cases of ICA rupture. Two variants of rupture were identified. ICA aneurysm avulsion from the artery in the area of aneurysmal neck with vascular wall defect development in 2 (0.6%) cases; in the second variant, ICA rupture was caused by frontal lobe traction. In the study group aneurysms of ophthalmic segment of ICA were found in 19 cases: intraoperative bleeding rate was 31% (6 cases). ICA was clipped in 33% of all cases of intraoperative bleeding. Among 6 patients with permanent ICA clipping, 5 died. Deaths were caused by cerebral infarction in 4 cases and acute blood loss in 1 case.
对470例随机分组的患者在大脑动脉瘤手术期间永久性颈内动脉夹闭的发生率、原因及结果进行了分析。6例（占所有手术的1.3%）进行了永久性颈内动脉夹闭。永久性颈内动脉夹闭的原因包括4例（0.9%）颈内动脉壁破裂，2例（0.4%）颈内动脉眼段动脉瘤出血。在所有颈内动脉破裂病例中均发现并经活检证实有颈内动脉粥样硬化改变。确定了两种破裂类型。2例（0.6%）为动脉瘤颈部区域动脉瘤从动脉撕脱并伴有血管壁缺损形成；第二种类型中，颈内动脉破裂是由额叶牵拉引起。在研究组中，发现19例颈内动脉眼段动脉瘤：术中出血率为31%（6例）。在所有术中出血病例中，33%进行了颈内动脉夹闭。在6例永久性颈内动脉夹闭患者中，5例死亡。4例死于脑梗死，1例死于急性失血。
