Background Due to their location, large and giant intracavernous and paraclinoid aneurysms remain a challenge for vascular neurosurgeons, We identified characteristics, surgical indications and treatment strategies of...Background Due to their location, large and giant intracavernous and paraclinoid aneurysms remain a challenge for vascular neurosurgeons, We identified characteristics, surgical indications and treatment strategies of large and giant intracavernous and paraclinoid aneurysms in 36 patients.Methods The pterional approach was routinely used. The cervical internal carotid artery was exposed for proximal control of parent vessel and retrograde suction decompression. Paraclinoid aneurysms were directly clipped, intracavernous pseudoaneurysm was repaired and the intracavernous aneurysms were trapped with extracranial-intracranial bypass of saphenous vein graft. Intraoperative electroencephalogram （EEG） and somatosensory evoked potential （SSEP） monitoring were used to detect cerebral ischemia during the temporary occlusion of parent arteries. Microvascular Doppler ultrasonography was used to assess blood flow of the parent and branch vessels. Endoscopy was helpful particularly in dealing with internal carotid artery posterior wall aneurysms. Postoperative digital subtraction angiography （DSA） was performed in 33 of the 36 patients.Results Thirty-two paraclinoid aneurysms were directly clipped, 1 intracavernous pseudoaneurysm was repaired and the other 3 intracavernous aneurysms were trapped with revascularization. Except for two patients who died in the early postoperative stage, 34 patients＇ follow-up was 6-65 months （mean 10 months） and a Glasgow Outcome Scale score of 4 to 5 at discharge. At the 6-month follow-up examination, Rankin Outcome Scale scores were 0 to 2 in 32 patients. EEG and SSEP monitoring changed in six patients. Twelve clips were readjusted when insufficient blood flow in parent and branch vessels was detected. Three posterior wall aneurysms were clipped.Conclusions Intracavernous aneurysms not amenable to endovascular treatment should be treated surgically and surgical treatment is the first option for paraclinoid aneurysms. The temporary parent vessel occlusion, retrograde suction 展开更多
目的采用系统回顾及荟萃分析的方法对已发表的床突旁动脉瘤手术夹闭和血管内栓塞治疗的系列文献进行分析。方法采用计算机检索PubMed和Web of Science电子数据库,获取1980年1月-2022年12月床突旁动脉瘤手术夹闭和血管内栓塞治疗的文献...目的采用系统回顾及荟萃分析的方法对已发表的床突旁动脉瘤手术夹闭和血管内栓塞治疗的系列文献进行分析。方法采用计算机检索PubMed和Web of Science电子数据库,获取1980年1月-2022年12月床突旁动脉瘤手术夹闭和血管内栓塞治疗的文献。分析文献中完全闭塞率、症状改善率和相关并发症发生率的差异。结果本研究系统回顾了37篇共2698例患者的临床资料,其中1164例患者接受了血管内栓塞治疗(血管内栓塞组),1534例患者进行了手术夹闭(手术夹闭组)。血管内栓塞组的完全闭塞率低于手术夹闭组,差异有统计学意义(OR=0.53,95%CI:0.37~0.77,P=0.001,I 2=0%)。手术夹闭组的症状改善率优于血管内栓塞组,差异有统计学意义(OR=0.26,95%CI:0.14~0.50,P<0.001,I 2=5.9%)。2组并发症发生率差异无统计学意义(OR=0.25,95%CI:0.03~2.20,P=0.21,I 2=7.43%)。结论与血管内栓塞相比,手术夹闭治疗可增高完全闭塞率,改善症状似乎更有利,但术中及术后并发症发生率也相应增高。展开更多
文摘Background Due to their location, large and giant intracavernous and paraclinoid aneurysms remain a challenge for vascular neurosurgeons, We identified characteristics, surgical indications and treatment strategies of large and giant intracavernous and paraclinoid aneurysms in 36 patients.Methods The pterional approach was routinely used. The cervical internal carotid artery was exposed for proximal control of parent vessel and retrograde suction decompression. Paraclinoid aneurysms were directly clipped, intracavernous pseudoaneurysm was repaired and the intracavernous aneurysms were trapped with extracranial-intracranial bypass of saphenous vein graft. Intraoperative electroencephalogram （EEG） and somatosensory evoked potential （SSEP） monitoring were used to detect cerebral ischemia during the temporary occlusion of parent arteries. Microvascular Doppler ultrasonography was used to assess blood flow of the parent and branch vessels. Endoscopy was helpful particularly in dealing with internal carotid artery posterior wall aneurysms. Postoperative digital subtraction angiography （DSA） was performed in 33 of the 36 patients.Results Thirty-two paraclinoid aneurysms were directly clipped, 1 intracavernous pseudoaneurysm was repaired and the other 3 intracavernous aneurysms were trapped with revascularization. Except for two patients who died in the early postoperative stage, 34 patients＇ follow-up was 6-65 months （mean 10 months） and a Glasgow Outcome Scale score of 4 to 5 at discharge. At the 6-month follow-up examination, Rankin Outcome Scale scores were 0 to 2 in 32 patients. EEG and SSEP monitoring changed in six patients. Twelve clips were readjusted when insufficient blood flow in parent and branch vessels was detected. Three posterior wall aneurysms were clipped.Conclusions Intracavernous aneurysms not amenable to endovascular treatment should be treated surgically and surgical treatment is the first option for paraclinoid aneurysms. The temporary parent vessel occlusion, retrograde suction
