상상돌기연부 내경동맥류의 코일색전술에 대한 미세수술 경부결찰술의 임상적 결과

Abstract

Objective. Because of the complex anatomical association between vascular, dural and bone structures, paraclinoid internal carotid artery (ICA) aneurysms remain a great challenge for vascular neurosurgeons. We studied the clinical outcomes of 61 paraclinoid ICA aneurysms by microsurgical clipping in comparison with endovascular coiling groups.

Methods. Between January 2008 and December 2012, we treated 61 paraclinoid ICA aneurysms by surgical clipping or endovascular coiling. Preoperative neurologic status and postoperative outcome were evaluated by the Glasgow Coma Scale (GCS) and the modified Rankin Scale (mRS). Postoperative hydrocephalus and vasospasm were reviewed by using their medical charts.

Results. Most patients were in good clinical conditions before the operations, and good treatment outcomes. Clinical vasospasm was observed in 5 patients after operation and hydrocephalus were occurred in 6 patients. There was no statistically significant difference between the surgical clipping group and endovascular coiling group regarding the aneurysm size, sex, GCS score, H-H grade, and mRS.

Conclusions. Paraclinoid ICA aneurysms are difficult to occlude surgically. However, there were no significant differences in the treatment results and complications when compared with coil embolization. In particular, an adequate surgical technique may endow better outcomes than coil embolization in the treatment of the large and/or wide-neck paraclinoid ICA aneurysms.