大面积外伤性脑梗死的血管成像特点与手术疗效  

Imaging features of CT angiography and the surgical outcome for massive traumatic cerebral infarction

作　　者：常会民[1] 胡辉华[1] 姚雪峰[1] 邱炜[1] 彭卫华[1] 苏军[1] 林鹏[1] 王军胜[1] 

机构地区：[1]武警广东总队医院神经外科,广州510507

出　　处：《中国微侵袭神经外科杂志》2013年第6期257-259,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨大面积外伤性脑梗死（traumatic cerebral infarction,TCI）的梗死区CT血管造影（CTA）成像特点及手术治疗效果。方法回顾性分析34例大面积TCI病例资料,采用CTA观察梗死区血管情况。并采取扩容、解痉、高压氧等综合治疗措施。结果 TCI闭塞血管主要为大脑中动脉、大脑前动脉或大脑后动脉以及基底动脉的远端小动脉或脑深部穿支血管和皮质小血管,未见大脑前动脉、大脑中动脉和大脑后动脉或基底动脉的主干血管闭塞。手术治疗28例,保守治疗6例。随访4~28个月,按GOS评分标准,恢复良好12例,中残8例,重残4例,植物生存3例,死亡7例。结论大面积TCI闭塞的血管主要为脑深部的穿支血管和皮质小血管,早期采取减压手术等综合治疗可取得较好疗效。Objective To investigate the imaging features of CT angiography（CTA） and the surgical outcome for massive traumatic cerebral infarction（TCI）.Methods The data of 34 severe head injury patients suffering massive TCI were analyzed retrospectively.The infarct zone was observed for vascular condition by CTA.A comprehensive treatment approach including fluid expansion,spasmolysis and hyperbaric oxygen was adopted for all the patients.Results The CTA on massive TCI area showed the occluded arteries were mainly the cortical arterioles or deep perforating arteries of the middle cerebral artery,anterior or posterior cerebral artery and basilar artery,but there was no occlusion of main cerebral artery such as the middle cerebral artery,anterior or posterior cerebral artery and basilar artery.Surgical operation was performed in 28 TCI patients and expectant symptomatic treatment in 6.In the follow-up period from 4 to 28 months,according to GOS,12 patients were cured,8 with moderate disability,4 with severely disability,3 in persistent vegetative state and 7 died.Conclusion The occluded arteries responsible for massive TCI are distal arteries or deep perforating arteries.Early detection and applicative surgical treatment can have favorable prognoses.

关 键 词：颅脑损伤 脑梗死 大面积 CT血管造影术 神经外科手术 

分 类 号：R651.15[医药卫生—外科学]