颅内创伤性假性动脉瘤的诊断及治疗  

Dia gnosis and treatm ent of intracranial traumatic pseudoaneurysms

作　　者：李钢[1] 陈宏尊[2] 刘成业[3] 郑杨睿 

机构地区：[1]海南省第三人民医院神经外科,三亚572000 [2]中国人民解放军第四二五医院神经外科,三亚572000 [3]中国人民解放军总医院海南分院神经外科,三亚572013

出　　处：《中华神经创伤外科电子杂志》2016年第5期271-277,共7页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

基　　金：三亚市医疗卫生科技创新项目(2014YW40)

摘　　要：目的探讨创伤性颅内假性动脉瘤的临床特点、手术方法及治疗效果。方法回顾性分析2008年10月至2014年12月在解放军第四二五医院和中国人民解放军总医院海南分院神经外科收治的14例创伤性颅内假性动脉瘤患者的临床表现、影像学特点和手术方法。1例海绵窦段动脉瘤行颈动脉血流阻断试验(Matas试验)后,行颈外动脉-大脑中动脉搭桥及动脉瘤孤立术,10例患者行血管内介入栓塞术,3例行假性瘤颈加固或夹闭术。结果手术切除获取假性动脉瘤标本3例,病理学检查显示为大量血栓及机化物,无弹性纤维或平滑肌细胞等正常血管壁成分,符合假性动脉瘤的特点。出院时GOS评分5分6例,4分4例,3分4例。14例患者随访了6个月至6年,其中10例DSA或CTA检查显示动脉瘤消失,载瘤动脉通畅,所有被随访的患者均未再出血。结论创伤性颅内假性动脉瘤是一种特殊动脉瘤,手术风险高、难度大。术前需充分认识到假性动脉瘤的特点,了解颅内血管的代偿情况。充分认识假性动脉瘤的特点并行个体化的手术治疗,能获得良好的预后。Objective To investigate the characteristics of traumatic intracranial pseudoaneurysms and the surgical treatment ethods and outcome. Methods The information of a total of 14 cases of traumatic intracranial pseudoaneurysms from October 2008 to December 2014 was analyzed retrospectively about the clinical manifestations, imaging characteristics and surgical method. One case with cavernous sinus segment carotid pseudoaneurysm underwent ECA-MCA bypass and aneurysm isolated after blood flow after blocking test （Matas test）; ten patients underwent endovascular interventional embolization; three patients underwent pseudoaneurysm neck reinforcement or clipping. Results Three cases underwent surgical removal of the aneuryms and had the pathological specimens. The pathological examination showed compound for a large number of thrombosis and machine, without inelastic fiber or smooth muscle cells and other normal blood vessels. It conforms to the characteristics of pseudoaneurysms. These patients’ GOS score when discharged from hospital including 5 in 6 cases, 4 in 4 cases and 3 in 4 cases. All the patients were followed up from 6 months to 6 years, 10 cases DSA and CTA examination showed aneurysms disappear and the parent artery patency. All patients were followed up without bleeding again. Conclusion Traumatic intracranial pseudoaneurysms is a special kind of aneurysm, with high operation risk and difficult. It is necessary to fully understand the characteristics of pseudoaneurysms and the status of compensatory intracranial vascular preoperative. If the characteristics of pseudoaneurysms can be fully understood and individualized surgical treatment can be undergone, the patients could have a good outcome.

关 键 词：颅脑创伤 颅内动脉瘤 假性动脉瘤 

分 类 号：R651.1[医药卫生—外科学]