摘要目的 探讨颅内外血管搭桥联合动脉瘤孤立术治疗颈内动脉床突旁大型和巨大型动脉瘤的方法及其疗效.方法 回顾性分析2014年4月至2018年2月苏州大学附属第一医院神经外科收治的12例颈内动脉床突旁动脉瘤患者的临床资料.12例患者共12个动脉瘤,包括8个巨大型(最大径＞25 mm)和4个大型(最大径为15～25 mm)床突旁动脉瘤.其中动脉瘤栓塞术后再出血1例,血栓性动脉瘤1例,血泡样动脉瘤1例.所有病例均行颅内外血管高流量搭桥联合动脉瘤孤立术.采用格拉斯哥预后评分(GOS)评估患者的预后.结果 术中行荧光素血管造影和血管超声检查均提示桥血管通畅.12例患者中,出院时疗效良好(GOS评分5分)9例,重度残疾(GOS评分2～3分)3例,无死亡病例.1例失随访,其余11例术后随访6～46个月,疗效良好10例(GOS评分4～5分),重度残疾(GOS评分2分)1例;10例患者的桥血管均通畅.结论 颅内外血管高流量搭桥联合动脉瘤孤立术是治疗颈内动脉床突旁大型和巨大型动脉瘤的有效方法.

abstractsObjective To explore the methods and effects of extracranial-intracranial (EC-IC) bypass and aneurysm trapping for the treatment of large and giant paraclinoid aneurysms.Methods The clinical data of 12 patients with paraclinoid aneurysms were analyzed retrospectively.Those patients were admitted to Department of Neurosurgery,the First Affiliated Hospital of Sooehow University between April 2014 and February 2018.There were totally 12 aneurysms in 12 patients,including 8 giant and 4 large aneurysms.There were 1 case of postoperative bleeding of aneurysm embolization and 1 case of thrombotic aneurysms and 1 case of blood blisterlike aneurysm.All cases underwent EC-IC high flow bypass and trapping of the aneurysms.The outcomes were evaluated based on the Glasgow Outcome Scale (GOS).Results Intraoperative fluorescein angiography and ultrasound suggested bridge vascular patency.The assessment at discharge indicated a GOS of 4-5 (good outcome) in 9 cases and GOS of 2-3 (severe disability) in 3 cases.There was no death.One was lost to followup.Eleven patients were followed up for 6-46 months post operation.The GOS of 4-5 (good outcome) was reported in 10 cases and 2 (severe disability) in I case.The bridge vascular patency was revealed in 10 cases.Conclusion The operation of EC-IC bypass combined with aneurysm trapping seems effective in the treatment of large and giant paraclinoid aneurysms.