烟雾病伴发颅内动脉瘤的诊断和治疗  

Diagnosis and treatment of intracranial aneurysms in moyamoya diseases

作　　者：于建军[1] 衡雪原[1] 孟凡国[1] 费昶[1] 

机构地区：[1]山东省临沂市人民医院神经外科,276003

出　　处：《中华神经外科杂志》2008年第9期689-691,共3页Chinese Journal of Neurosurgery

摘　　要：目的探讨烟雾病伴发颅内动脉瘤的诊断和治疗。方法回顾性分析78例烟雾病患者的临床表现、影像学特点及治疗方法。结果78例烟雾病中，8例合并动脉瘤（10．3％），其中6例表现为颅内出血，2例表现为缺血症状；其中2例位于Willis环远端血管，6例位于Willis环。3例行显微外科手术夹闭，3例行血管内栓塞治疗，2例保守治疗。平均随访26个月（8-40个月），1例在右侧后交通动脉动脉瘤栓塞治疗12个月后，再次出现左侧外囊出血死亡，7例无再次颅内出血。结论烟雾病患者应行全脑血管造影检查，部分烟雾病可伴发动脉瘤。位于Willis环的动脉瘤可行显微外科手术治疗或血管内栓塞治疗，位于Willis环远端血管的动脉瘤治疗，有待进一步探讨。Objective To report the diagnosis and treatment of intracranial aneurysm in patients with moyamoya disease. Method Retrospectively analysis the clinical manifestation, imaging characteristic and treatment of 78 cases of moyamoya disease during a 5-year period. Results Seventy-eight patients were diagnosed as moyamoya diseases, 8 with intracranial aneurysms, in which 6 cases presented with intracranial hemorrhage, 2 cases with ischcmic symptoms. Aneurysm located at distal to the Willis circle in 2 cases and at Willis circle in 6. Three aneurysms were treated surgically and 3 were treated endovascularly. Other two patients were treated conservatively. Clinical and angiographic follow - up were obtained for all patients, 1 patient with right posterior communicating artery aneurysm treated endovascularly died 12 months after procedure and 7 patients were free from rebleeding. Conclusions Cerebral angiograms should be performed for patients diagnosed as moyamoya disease, in which 10.3% patients developed aneurysms. Aneurysms locating at Willis circle can be treated neurosurgically or endovascularly. However, the therapy of aneurysms locating at the vessels distal to Willis circle was still unclear.

关 键 词：脑底异常血管网病 颅内动脉瘤 诊断 治疗 

分 类 号：R686[医药卫生—骨科学]