成人烟雾病合并脑室出血手术时机及方案的选择  

Surgical timing and managements for adult moyamoya disease complicated with intraventricular hemorrhage

作　　者：王振宇[1] 刘泠[1] 胡晓[1] 殷成[1] 刘灵童[1] 陈隆益[1] 李志立[1] 谭海斌[1] 黄光富[1] Wang Zhenyu;Liu ling;Hu Xiao;Yin Cheng;Liu Lingtong;Cheng Longyi;Li Zhili;Tan Haibin;Huang Guangfu(Department of Neurosurgery,Sichuan Provincial People's Hospital,Chengdu Sichuan 610072,China)

机构地区：[1]四川省人民医院神经外科,四川成都610072

出　　处：《遵义医学院学报》2019年第2期191-195,共5页Journal of Zunyi Medical University

基　　金：四川省卫健委基金资助项目(NO:30305030424)

摘　　要：目的探讨成人烟雾病合并脑室出血手术时机及方案的选择。方法回顾性分析2010年8月至2018年7月四川省人民医院神经外科32例烟雾病合并脑室出血患者的临床资料。单侧脑室出血17例,双侧脑室出血15例,双侧脑室出血伴有意识障碍及高颅压症状10例脑室外引流。7例患者合并动脉瘤(21.9%),脉络膜前动脉瘤1例,脉络膜后动脉远端动脉瘤5例,大脑中动脉末梢动脉瘤1例。开颅动脉瘤夹闭1例,血管内介入栓塞治疗3例,3例未处理。32例患者12例(37.5%)进行双侧直接间接联合血运重建手术,11例在亚急性期完成血管重建手术,21例3周后(慢性期)完成。结果全部患者32例术后未并发脑积水。血管重建手术时机亚急性期与慢性期的术后改良Rinkin量表评分对比无统计学差异(P>0.05)。随访3～96个月,2例再出血(6.3%),1例为对侧再出血,1例(合并动脉瘤未处理)出院1个月死亡。7例动脉瘤中6例动脉瘤消失, 1例再破裂出血。术中桥血管通畅率100%,术后3个月桥血管通畅率95%。结论烟雾病脑室出血不需要脑室外引流的患者可选择亚急性期进行血运重建手术,脑室外引流后脑脊液循环障碍解除,尽早血运重建手术,动脉瘤的处理应根据情况设计个体化方案。Objective To investigate the surgical timing and managements for adult moyamoya disease(MMD) complicated with intraventricular hemorrhage(IVH).Methods A total of 32 adult patients with moyamoya disease complicated with IVH enrolled in the Department of Neurosurgery,Sichuan Provincial People’s Hospital from August,2010 to July,2018,were retrospectively analyzed.There were 17 cases of unilateral IVH,15 cases of bilateral IVH.Bilateral IVH with conscious disturbance and high intracranial pressure symptoms in 10 cases were treated by external ventricular drainage(EVD).Intracranial aneurysms occurred in 7 patients(21.9%),choroidal anterior artery aneurysm existed in 1 case,distal posterior choroidal artery aneurysms were found in 5 cases,and middle artery peripheral aneurysm existed in 1 case.Intracranial aneurysm clipping was used for 1 case,endovascular embolization therapy was executed in 3 cases,and non-operative treatment was used for the another 3 cases.Bilateral direct/indirect revascularization was executed in 12 cases of all cases(37.5%) after 3 to 6 months.Eleven patients of subacute phase was operated by revascularization and the other 21 patients of chronic phase also received above operation 3 weeks later.Results No patients was accompanied with hydrocephalus after operation.No significant difference of the postoperative modified Rinkin scale scores between the subacute and chronic phases of revascularization surgery was shown.During the follow-up period of 3 to 96 months,2 patients occurred rebleeding(6.3%),1 patient suffered from contralateral hemorrhage,and 1 patient with non-operative aneurysm died 1 month after leaving hospital.In 7 cases with aneurysm,1 aneurysm ruptured again and the other 6 aneurysms showed negative.Intraoperative graft patency rate was 100%,and the graft patency rate was 95% 3 months after opreration.Conclusion Adult MMD patients with IVH,who do not need EVD,may apply for the subacute phase for revascularization surgery.The revascularization should be performed as soon as possi

关 键 词：烟雾病 脑室出血 脑室外引流 血运重建 搭桥 

分 类 号：R743.9[医药卫生—神经病学与精神病学]