The Anlysis Of Clinical Diagnosis And Operative Treatment Of Blood Blister-like Aneurysms In Super-clinoid Segment Of ICA

Objective:Clinical studies on domestic blood blister-like aneurysms(BBA)is little.This study summarizes the five cases of clinical datas and experience in the treatments of patients with BBA,explore their diagnostic criteria,the choice of different operative methods and prognosis,to provide reference for clinical.Clinical data and methods:Retrospectively analyzed the general clinical data,diagnosis,treatment process and follow-up results of 5 patients with BBA,which were treated in China-Japan union hospital neurosurgery department during the December2010 to December 2016.2 males and 3 females,aged 37 to 56 years,mean46.7 years of age,a history of hypertension 4 cases,two cases of diabetes,no significant history of head and neck trauma.The first clinical manifestations: headache five cases,two cases of unconsciousness,nausea and vomiting three cases,slurred speech,physical activity and other ischemic symptoms ineffective two case.The head CT examination,5 patients showed subarachnoid hemorrhage,Hunt-Hess class II in 2 cases,level III in 3cases.Hospital emergency head CTA check determined 3 cases of patients with intracranial aneurysms,further clear intracranial aneurysm patients after DSA examination in 2 cases,including 1case definited diagnosis after 3d-routine DSA examination.5 patients were found to have different levels of atherosclerosis in preoperative DSA examination.3 cases internal carotid artery aneurysm sited in the antetheca,2cases in the anterolateral.Based on the characteristics of the aneurysm,patient general condition,operation risk and willingness of family factors,such as reasonable selection procedure,improve the preoperative preparation;surgical treatment.Postoperative imaging,and regular follow-up review.At the same time,combined with the domestic and foreign literatures related by aneurysm diagnosis and treatment,systematicly sorting and analysis.Results:1 in 5 patients with BBA routine craniotomy aneurysm clipping +aneurysm neck package,1 aneurysm wrapped after operation,1 simple routine aneurysm clipping,1 underwent stent assisted coil embolization,1 of coated stent implantation treatment by aneurysm.Follow-up of 1 months to 4 years,an average of 18.4 months,Modified Rankin scale 4 points in 3 patients 1 case,2 in 1 case,1 in 1case and 0 in1 case.Conclusion:1.BBA is a special type of complex intracranial aneurysms,the patients’ age,be taken into account to Hunt-Hess classification,blood loss,aneurysms,family members intend to choose treatment.2.Surgical operation treatment of intracranial BBA,is one of the feasible operation method.3.In patients under the premise of economic conditions allow,for BBA patients,preoperative preparation at the same time 3 d DSA and 3 d-CTA images data,will be more conducive to surgical operation treatment.4.The use of special operation skills,skilled operation at the same time,to reduce the operation risk of BBA,to improve the cure rate.5.BBA treatment need not only the whole neurosurgery team cooperation,but also the intervention practitioner and the coordination of anesthesia physician.