论文部分内容阅读
BACKGROUND:The two problems in treating intracranial aneurysm are the vascular reconstruction and brain protection,especially for complex internal carotid artery-posterior communicating artery(ICA-PComA)aneurysms.OBJECTIVE:To analyze the anatomic features and operative technique of complex ICA-PComA aneurysms,and investigate how to better protect the brain tissue.DESIGN:A retrospective case analysis.SETTING:Department of Neurosurgery,Dalian Central Hospital.PARTICIPANTS:Totally 154 inpatients with ICA-PComA aneurysms were selected from the Department of Neurosurgery,Dalian Central Hospital from January 1998 to December 2006,including 19 cases(12.3%)of complex ICA-PComA aneurysms,8 males and 11 females,38-67 years of age.Informed contents for surgery and observation were obtained from all the patients or their relatives.METHODS:The clinical manifestations,including initial symptoms and Hunt&Hess grading,were observed.Corresponding strategies were selected for different types of ICA-PComA aneurysms.The patients were followed up at 3 months postoperatively.According to the results of Glasgow scoring,the curative effects were classified as good(4-5 points),bad(2-3 points)and dead(1 point).The results at discharge were taken as early results,whereas the follow-up results as late results.MAIN OUTCOME MEASURES:Clinical manifestations and curative effects of the patients.RESULTS:All the 19 patients with ICA-PComA were involved in the analysis of results.For clinical manifestations,the initial symptoms were subarachnoid hemorrhage(n =15),paralysis of oculomotor nerve(n =3),and occasional attack(n =1);The Hunt&Hess grading was grade Ⅰ in 4 cases,grade Ⅱ in 6 cases,grade Ⅲ in 6 cases,grade Ⅳ in 2 cases,and grade Ⅴ in 1 case.The curative effects were that aneurysm breakage and bleeding occurred in 6 cases perioperatively,uncomplete clipping of aneurysm in 2 cases and constriction of parent artery in 1 case.The complications were nervous and ischemic ones.The early outcome was good in 12 cases and bad in 7 cases,no one died.The late outcome was good in 17 cases and bad in 2 cases.CONCLUSION:Complex ICA-PComA aneurysm is a particular aneurysm,thus different operative strategies should be adopted according to the conditions to improve the operative outcome and reduce ischemic and nervous injuries.
BACKGROUND: The two problems in treating intracranial aneurysm are the vascular reconstruction and brain protection, especially for complex internal carotid artery-posterior communicating artery (ICA-PComA) aneurysms. OBJECTIVE: To analyze the anatomic features and operative technique of complex ICA-PComA aneurysms , and investigate how to better protect the brain tissue. DESIGN: A retrospective case analysis. SETTING: Department of Neurosurgery, Dalian Central Hospital. PARTICIPANTS: Totally 154 inpatients with ICA-PComA aneurysms were selected from the Department of Neurosurgery, Dalian Central Hospital from January 1998 to December 2006, including 19 cases (12.3%) of complex ICA-PComA aneurysms, 8 males and 11 females, 38-67 years of age. Informed contents for surgery and observation were obtained from all the patients or their relatives.METHODS : The clinical manifestations, including initial symptoms and Hunt & Hess grading, were observed. Resolution responsiveness were selected for different types of ICA-PCom A aneurysms. The patients were followed up at 3 months postoperatively. According to the results of Glasgow scoring, the curative effects were classified as good (4-5 points), bad (2-3 points) and dead (1 point). Results at discharge were taken as early results, but the follow-up results as late results. MAIN OUTCOME MEASURES: Clinical manifestations and curative effects of the patients .RESULTS: All the 19 patients with ICA-PComA were involved in the analysis of results. For clinical manifestations of the initial symptoms were subarachnoid hemorrhage (n = 15), paralysis of oculomotor nerve (n = 3), and occasional attack (n = 1); The Hunt & Hess grading was grade I in 4 cases, grade II in 6 cases , grade Ⅲ in 6 cases, grade Ⅳ in 2 cases, grade Ⅴ in 1 case. The curative effects were that aneurysm breakage and bleeding occurred in 6 cases perioperatively, uncomplete clipping of aneurysm in 2 cases and constriction of parent artery in 1 case The complications were nervous and ischemic ones come was good in 12 cases and bad in 7 cases, no one died. late: was was in 17 cases and bad in 2 cases. CONCLUSION: Complex ICA-PComA aneurysm is a particular aneurysm, thus different operative strategies should be applied according to the conditions to improve the operative outcome and reduce ischemic and nervous injuries.