Individualized Surgical Treatment Of Complex Intracranial Aneurysms

Objective:Analyze the surgical methods and clinical treatment effects of complex aneurysms such as bed aneurysms,vesicular aneurysms,and giant aneurysms.Methods:20 cases of microsurgery for the treatment of complicated aneurysms in our hospital from 2016.1 to 2019.1 were selected.Among them,15 cases had sudden headache,and the results of head CT examination showed SAH.MRA showed 5 cases of intracranial aneurysms.There are 8 males and 12 females.The average age is 52.4 years old.The surgical strategy is decided based on the special type of aneurysm in patients,and intraoperative neurophysiological monitoring is performed.Results:There were 5 cases of giant aneurysm,among which 2 cases showed positive results in BOT assay before operation.For those showed positive BOT results,left external carotid artery-great saphenous vein-middle cerebral artery M2 bypass + left internal carotid artery occlusion and superficial temporal artery-middle cerebral artery bypass graft + middle cerebral artery occlusion were performed respectively.The BOT assay results of the remaining cases were negative,and the internal carotid artery clipping was performed.All patients recovered well,and GOS score of 5 points after surgery.The modified Rankin score was 0 points from 3 months to 12 months after surgery.One case of posterior inferior cerebellar aneurysm underwent occipital artery-inferior cerebellar artery anastomosis plus posterior inferior cerebellar artery aneurysm.Two cases of posterior inferior cerebellar aneurysm were treated with aneurysm clipping.One case of abductor aneurysm underwent external carotid artery-iliac artery-brain middle artery bypass graft + internal carotid artery clipping.One case of cavernous sinus aneurysm showed negative results for BOT assay,and internal carotid artery clipping was performed.The basilar artery aneurysm is directly clamped.The GOS score was 2 points after the aneurysm of the bed,and the modified Rankin was 5 points.The rest of cases’ GOS scores are all 5 points.The modified Rankin score was 0 points 3-12 months after surgery.In 3 cases of BBA,the autologous dura mater was used to wrap the neck of the aneurysm,and then the neck of the titanium clip was clamped with titanium clips.The patients recovered well after surgery,and the GOS score were all 5 points.The modified Rankin score were 0 points 3-12 months after surgery.Eight patients with MIA included a basilar artery aneurysm and a large aneurysm in the left brain.For the case with a large aneurysm in the left brain,the superficial temporal artery-middle cerebral artery bypass graft + middle cerebral artery occlusion + left anterior cerebral aneurysm clipping were performed.For the rest of cases were directly clamped.Electrophysiological examination was applied during the operation and the results were normal.After clipping,the neck of aneurysm was pierced without fresh bleeding.After surgery,the GOS scores were all 5 points.The modified Rankin scores were 0 points 3-12 months after surgery.Conclusion:Intracranial complex aneurysms are complicated and variable,and there is no fixed surgical method.It is necessary to combine the experience of the surgeon and the patient’s condition to develop the surgical method with lowest risk.A deep understanding of the anatomy of the skull base is a prerequisite for a successful surgery.Combing fluorescein angiography,electrophysiological detection,neuroendoscopy and other multi-adjuvant measures can do a lot of help for the operation.The intracranial and extracranial vascular bypass is the last barrier to treat complex aneurysms.