出血性烟雾病合并动脉瘤的治疗和预后  

Treatment and prognosis of intracranial aneurysms associated with hemorrhagic moyamoya disease

作　　者：张晓斌[1] 黄理金[1] 文军[1] 黄伟佳[1] 康晓雨[1] 邓仕凤 郭鸿华 

机构地区：[1]南方医科大学第三附属医院神经外科,广州510630

出　　处：《中华神经外科杂志》2015年第1期22-26,共5页Chinese Journal of Neurosurgery

摘　　要：目的 探讨出血性烟雾病合并动脉瘤患者的治疗方法及预后.方法 纳入2011年6月至2014年6月南方医科大学第三附属医院神经外科诊治的10例（12个动脉瘤）出血性烟雾病合并动脉瘤患者.12个动脉瘤中,7个位于Willis环,2个位于基底节区,3个位于侧支吻合动脉;责任动脉瘤9个,非责任动脉瘤3个.7个Willis环动脉瘤中,6个行血管内栓塞或手术夹闭,1个保守治疗;2个基底节区动脉瘤均给予保守治疗;3个侧支吻合动脉瘤,2个采用33％ Glubran胶栓塞,1个给予保守治疗.结果 （1）积极治疗的6个Willis环动脉瘤均无动脉瘤残留;1个保守治疗者,动脉瘤稳定.2个基底节区动脉瘤,分别于保守治疗后3、8个月动脉瘤消失.3个侧支吻合动脉瘤,栓塞者无动脉瘤残留;保守治疗者,14d后再次出血而死亡.（2）出院时改良Rankin量表评分,0分5例,1分2例,2分1例,3分1例,6分1例.（3）9例获得2 -36个月随访,积极治疗及保守治疗后消失的动脉瘤均无复发,保守治疗的1例动脉瘤稳定.结论 给予烟雾病合并不同类型的动脉瘤患者不同的治疗方式,疗效可能更好.Objective To investigate the treatment and prognosis of intracranial aneurysms associated with hemorrhagic moyamoya disease.Methods Ten patients （12 aneurysms） with aneurysms associated with hemorrhagic moyamoya disease were included.Of the 12 aneurysms diagnosed by DSA,7 were found distributed around the circle of Willis,2 in the basal ganglia and 3 on the collateral vessels.Nine aneurysms were ruptured and 3 were unruptured.Six of the 7 aneurysms around the circle of Willis were treated by endovascular embolization or surgical clipping,while the remaining 1 case was treated conservatively.Two aneurysms in the basal ganglia were managed with conservative treatment.Of the 3 aneurysms on the collateral vessels,2 were occluded by 33% Glubran glue injection,1 was treated conservatively.Results （1） Six aneurysms around the circle of Willis were successfully and completely occluded or clipped.The other 1 patient was managed with conservative treatment and the aneurysm was stable.Two aneurysms in the basal ganglia were followed up conservatively and disappeared 3 and 8 months later,respectively.Two of the 3 aneurysms on the collateral vessels got complete embolization.The patient treated conservatively experienced a second episode of bleeding and died 14 days after the first hemorrhage.（2） Outcome was assessed using the modified Rankin scale （mRS） when patients discharged,0 point in 5 cases,1 in 2 cases,2 in 1 case,3 in 1 case,4 in 0 case and 6 in 1 case.（3） The follow-up period of the 9 patients was between 2 to 36 months.Re-examination by DSA revealed no recurrence of the aneurysms occluded or clipped and the aneurysms disappearing spontaneously.The aneurysm treated conservatively remained stationary.Conclusions Patients with different types of aneurysms associated with moyamoya disease should undergo different treatments,which may be more appropriate and more effective.

关 键 词：脑底异常血管网病 颅内动脉瘤 出血 治疗方案 

分 类 号：R743.3[医药卫生—神经病学与精神病学]