摘要目的 探讨颈内动脉(ICA)床突上段动脉瘤术中瘤颈撕脱的处理方法.方法 自1997年12月至2011年8月期间行颅内动脉瘤夹闭765例,其中ICA动脉瘤288例,有8例术中瘤颈撕脱.在早期的4例术中不得不将ICA夹闭；后期的4例术中采用自体硬脑膜包绕技术加窗式动脉瘤夹成功夹闭破裂口.结果 8例中,早期术中夹闭ICA的4例,术后2例死亡(GOS评分1分),2例遗留神经功能障碍(GOS评分3分)；后期保留ICA的4例术后均恢复良好(GOS评分5分).结论 在ICA床突上段动脉瘤手术中,一旦发生瘤颈撕脱无法夹闭破裂口时,不要盲目闭塞ICA,可采取自体硬脑膜加窗式动脉瘤夹闭术,既可闭塞ICA的破裂口,又可保持ICA的通畅性.

abstractsObjective To study the microsurgical skills in the management of splitting neck of aneurysm of supraclinoid part of internal carotid artery ( ICA ).Methods 765 patients with intracranial aneurysms had been operated between December 1997 and August 2011.Among 288 cases of aneurysms of supraclinoid part of ICA,the necks of aneurysms in 8 cases were splitted from the trunks of ICA during operation.In the first 4 cases the ICAs had to be occluded.In the last 4 cases the ruptured holes were clipped with autogenous dura maters and straight angled ring aneurysm clips.Results In the first 4 cases with occluded ICA,2 patients died (GOS:1 score) and 2 had serious neurological disfunction(GOS:3scores).The last 4 cases with protected ICA,all patients have good results (GOS:5 scores ).Conclusions During the surgery of aneurysm in the supraclinoid part of ICA,if the neck is splitted from ICA,instead of ligation the ICA,we should clip the rupture hole with autogenous dura mater and aneurysm clip and protect ICA in order to avoid serious consequences.