目的 探讨颈内动脉床突上段血泡样动脉瘤(BBA)的临床特点、治疗方法及疗效.方法 回顾性分析2010年1月至2016年1月四川大学华西医院神经外科收治的40例BBA患者的临床资料.男性14例,女性26例,年龄25～64岁,平均44.7岁.38例患者为蛛网膜下腔出血(SAH),2例为体检偶然发现的未破裂动脉瘤.开颅手术治疗22例,分别采用夹闭、包裹及孤立等方式;介入治疗18例,采用单支架或多支架辅助弹簧圈栓塞等方法.预后评估采用改良Rankin评分.术后随访采用CT血管造影检查.结果 开颅手术治疗的22例患者中,动脉瘤直接夹闭18例,夹闭加包裹3例,颈内动脉孤立1例;术中动脉瘤破裂5例,术后发生脑梗死6例,死亡4例.介入治疗的18例患者,单支架加弹簧圈8例,多支架辅助弹簧圈栓塞10例.介入过程中2例发生出血;1例术后24 h发生大面积脑梗死.随访时间6～72个月,平均26.8个月.开颅患者改良Rankin评分0～2分16例,3分1例,4分1例;介入治疗患者改良Rankin评分0～2分15例,4分1例.开颅手术患者未见复发,介入治疗患者中2例动脉瘤复发,再次栓塞治疗.结论 颈内动脉床突上段BBA是一种特殊类型的复杂动脉瘤,开颅和介入治疗均具有较高的风险和并发症,采用适合的手术方式可取得满意的效果.%Objective To explore the clinical characteristics,therapeutic methods and effects ofblood blister-like aneurysms (BBA) of the supraclinoid segment of the internal carotid artery (ICA).Methods A total of 40 patients with BBAs of the ICA treated at Department of Neurosurgery of West China Hospital between January 2010 and January 2016 were retrospectively reviewed.There were 14 males and 26 females with the mean age of 44.7 years (ranging from 25 to 64 years).There were 38 patients presented with subarachnoid hemorrhage (SAH),and 2 patients were found incidentally with unruptured aneurysms in regular examination.Surgical treatment was performed in 22 patients,including direct clipping,clipping over wrapping and trapping.Endovascular treatment with single or multiple stents and coiling was performed in 18 patients.Clinical outcomes were assessed with modified Rankin Scale.The patients were followed up with CT angiography.Results Direct clipping of BBA was performed in 18 patients,clipping over wrapping in 3 patients and trapping of ICA in 1 patient.Intraoperative rupture occurred in 5 patients.Postoperative cerebral infarction developed in 6 cases,4 patients died.Single stent-assisted coiling was performed in 8 cases,and multiple stents with coiling in 10 patients.Procedure-related hemorrhage occurred in 2 patients,postoperative massive cerebral infarction developed in 1 patient with stent-assisted coiling.The follow-up time was 26.8 months (ranging from 6 to 72 months),among the patients with surgery,good results (modified Rankin Scale 0-2) were achieved in 16 patients;one patient was score 3,and the other was 4.In endovascular group,15 patients had good results and one with mRS 4.Follow-up angiography revealed recurrence of BBA in 2 patients treated with stent and coiling,which was retreated with coiling.No recurrence was found in surgical group.Conclusions BBA of the supraclinoid ICA is a specific and complicated intracranial aneurysm with high risk and complications no matter the treatment is surgical or endovascular,take proper operation methods could achieve satisfactory results.
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