关键词:  动脉瘤, 颈内动脉, 显微外科手术, 血管内手术

Abstract:

Objective：To explore the surgical treatment of paraclinoid aneurysms and evaluate the safety and efficacy of microsurgical clip and endovascular embolization of paraclinoid aneurysms. Methods:The data of 28 patients with 30 paraclinoid aneurysms receiving surgical treatment were retrospectively analyzed. According to Barami classification, 4 aneurysms were type Ⅰa, 5 aneurysms type Ⅰb, 13 aneurysms type Ⅱ, 4 aneurysms type Ⅲa, 1 aneurysm type Ⅲb, and 3 aneurysms type Ⅳ. In the study, 15 cases with 17 paraclinoid aneurysms received microsurgical treatment, of which 3 cases underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass firstly and then aneurysms were trapped. The other 13 cases received endovascular embolism, in which balloon assistant technology was performed in 3 cases and stent assistant technology in another 3 cases. Results: All the 30 paraclinoid aneurysms were treated. One patient with bilateral paraclinoid aneurysms became blind after bilateral microsurgical procedures and another patient was unexceptedly dead 10 d after operation. Vasospasm resulting with cerebral infarction occurred in one case who received endovascular embolism, while two patients suffered from hydrocephalus. Ten cases of microsurgical group and 9 cases of interventional group were followed up with digital subtraction angiography, which disclosed that 9 cases of microsurgical group were clipped completely, while 7 aneurysms of interventional group were completely embolised. One aneurysm recurred and enlarged 12 months after stent assistant embolism, and after STA-MCA bypass and bilateral anterior cerebral artery anastomy and aneurysm insulation, the patient recovered well. When the patients were discharged, their Glasgow outcome scales showed that 18 cases were with 5, 8  with 4, 1 with 3 and 1 with 0.Conclusion: According to the classification, and with appropriate treatment, the patients with paraclinoid aneurysms will get good outcomes both with microsurgical clipping and with endovascular embolization.

Key words: Aneurysm, Carotid artery, internal, Microsurgery, Endovascular procedures