Kyoshima K, Kobayashi S, Nitta J, Osawa M, Shigeta H, Nakagawa F
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Acta Neurochir (Wien). 1998;140(9):933-42. doi: 10.1007/s007010050196.
An intraoperative classification of intradural internal carotid artery (ICA) aneurysms not related to the arterial division but based on their operative presentation and clipping techniques is introduced. On the basis of the surgeon's view of the operative field via the pterional approach in 156 operated intradural ICA aneurysms in 143 patients, these aneurysms were classified according to their location in relation to the long axis of the ICA as either proximal, middle or distal in type and also according to their relation to the cross section of the ICA as either lateral, medial, ventral or dorsal in type. Numerically the largest in frequency is the middle type of aneurysm by axial location and the lateral type of aneurysms by cross sectional location. Eighty five percent of the lateral type aneurysms were at the arterial division. The majority of the large to giant aneurysms were of the ventral type and no dorsal type aneurysms were seen. About one third of the ICA aneurysms in this series were located free of the arterial division. All dorsal type aneurysms and most of the medial type aneurysms were not related to the arterial division. Clipping techniques were classified into perpendicular and parallel clipping, as to the direction of the clip-blades in relation to the carotid axis. The parallel clipping was further classified into forward clipping, in which a clip was applied from the distal side of the ICA, and reversed clipping, in which a clip was applied from the proximal side of the ICA. Most of the aneurysms located at the arterial division required the perpendicular clipping and those free of the arterial division required the parallel clipping. Furthermore, the forward clipping was useful for proximal type aneurysms and the reversed clipping for distal type aneurysms. For the middle type aneurysms clipping was performed bidirectionally. This classification includes all types of the ICA aneurysms located at any points along its long axis and on its cross section, and is useful for planning safe and exact clipping of the ICA aneurysms.
本文介绍了一种基于手术表现和夹闭技术的硬脑膜内颈内动脉（ICA）动脉瘤术中分类方法，该分类与动脉分支无关。通过翼点入路，对143例患者的156个硬脑膜内ICA动脉瘤手术视野进行观察，根据动脉瘤相对于ICA长轴的位置，将其分为近端型、中间型或远端型；根据其与ICA横截面的关系，分为外侧型、内侧型、腹侧型或背侧型。从数量上看，按轴向位置，中间型动脉瘤出现频率最高；按横截面位置，外侧型动脉瘤出现频率最高。85%的外侧型动脉瘤位于动脉分支处。大多数大型至巨大型动脉瘤为腹侧型，未见背侧型动脉瘤。本系列中约三分之一的ICA动脉瘤位于无动脉分支处。所有背侧型动脉瘤和大多数内侧型动脉瘤均与动脉分支无关。根据夹片相对于颈动脉轴的方向，夹闭技术分为垂直夹闭和平行夹闭。平行夹闭进一步分为正向夹闭（从ICA远端施加夹子）和反向夹闭（从ICA近端施加夹子）。大多数位于动脉分支处的动脉瘤需要垂直夹闭，而无动脉分支处则需要平行夹闭。此外，正向夹闭对近端型动脉瘤有用，反向夹闭对远端型动脉瘤有用。对于中间型动脉瘤，则进行双向夹闭。该分类涵盖了沿ICA长轴及其横截面上任何位置的所有类型ICA动脉瘤，有助于规划安全、精确的ICA动脉瘤夹闭手术。
