颌内动脉搭桥治疗颅内巨大动脉瘤  

Radial artery graft for bypass of internal maxillary artery to intracranial artery： a wise choice for complex intracranial aneurysms

作　　者：石祥恩[1] 张永力[2] 刘方军[2] 孙玉明[2] 周忠清[2] 钱海[2] 杨扬[1] 于在涛[1] 

机构地区：[1]首都医科大学附属复兴医院神经外科,100038 [2]北京三博脑科医院

出　　处：《中华神经外科杂志》2013年第1期37-40,共4页Chinese Journal of Neurosurgery

基　　金：北京市科学技术委员会首都临床特色应用研究项目（Z121107001012061）;首都卫生发展科研专项（2011-7011-02）

摘　　要：目的探讨颌内动脉与颅内动脉搭桥治疗复杂性动脉瘤的方法。方法22例颅内巨大动脉瘤患者，颈内海绵窦段8例，大脑中动脉6例，眼动脉段4例，床突上段1例，椎一基底动脉交接处2例，基底动脉下段1例。瘤体有重要穿通动脉发出9例。3例经弹簧圈治疗后，动脉瘤复发。取7cm桡动脉做移植血管，先行颌内动脉与桡动脉端一端吻合。颈内动脉瘤做桡动脉与中动脉M2起始部端一侧吻合，椎基底动脉瘤做大脑后动脉P2段近端行端一侧吻合。动脉搭桥后，16例海绵窦段和床突上段动脉瘤做孤立术，6例动脉瘤有穿动脉发出，仅作动脉瘤近端阻断远端开放，使搭桥血流逆流入动脉瘤体内，保持穿通动脉血流。结果20例术后恢复良好，移植搭桥血管畅通，动脉瘤消失。2例吻合血管未通，但无缺血性神经功能缺失表现。22例患者经3个月-3．3年随访，21例恢复正常生活，1例因患其他疾病需要照顾。结论用桡动脉移植，颌内动脉作为供血动脉与颅内动脉搭桥，可得到较高的搭桥通畅率和较小的损伤效果。Objective To report results of the internal maxillary artery bypass （ MA ） to the intracranial arteries with radial artery （RA） graft for complex aneurysms. Methods 22 patients with complex aneurysms underwent MA bypass with radial artery graft. Aneurysms were located in the cavernous segment of the internal carotid artery （C3） in 8 cases, middle cerebral artery （MCA） in 6 cases, ophthalmic segment in 4 cases, supraclinoid segment （C4） in 1 case, vertebrobasilar junction in 2 cases, and low basilar trunk in 1 case. Vital branches or perforating arteries arose at the origin of aneurysm bodies in 9 cases. 4 patients had recurrent filling aneurysms or migration after coiling treatment. A 7 cm RA harvest was gathered from the forearm. An end - to - end anastomosis was first performed between the proximal radial artery graft and the proximal MA. In internal carotid aneurysms, the distal end of the RA graft was then anastomosed to the side of the temporal - occipital branch of the MCA, while the distal end of the RA graft was anastomosed to the side of the P2 segment of the PCA for vertebrobasilar aneurysms. After the completion of all anastomosis, the aneurysms were trapped in 16 cases, and proximal artery patent arteries was occluded only for creating reversal flow bypasses to aneurysms related to the small perforating arteries in 6 cases. Results 20 patients obtained excellent recovery ; furthermore, patency of the bypass graft with elimination of aneurysms was confirmed in 20 patients. Patency of the bypass was unidentifiable in the remaining 2 patients, however, both patients did not have any symptoms without patent bypass in spite of the occlusion. 22（ 100% ）patients were followed- up between 3 months and 3 years after surgery. 21 patients recovered their normal lives, while 1 patient still needed assistance for daily life for a disease unrelated to the surgery.. Conclusion The selection of maxillary artery bypass to the intracranial artery distal to the aneurysm with subsequent reversal f

关 键 词：颅内动脉瘤 脑血管重建术 血管移植 上颌动脉 桡动脉 

分 类 号：R651.1[医药卫生—外科学]