颅内外高流量血管搭桥术治疗颈内动脉大型和巨大型动脉瘤的临床体会  

Clinical experience in the extracranial-intracranial high flow bypass surgery for the treatment of large and giant aneurysms of internal carotid artery

作　　者：甄英伟 焦贺男 占益平 郭社卫 王兆斌[2] 周国胜[1] Zhen Yingwei;Jiao Henan;Zhan Yiping;Guo Shewei;Wang Zhaobin;Zhou Guosheng(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Neurosurgery,Puyang Oilfield General Hospital,Puyang 457001,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450052 [2]濮阳市油田总医院神经外科,濮阳457001

出　　处：《中华神经外科杂志》2022年第11期1132-1138,共7页Chinese Journal of Neurosurgery

摘　　要：目的初步探讨颅内外高流量血管搭桥术治疗颈内动脉大型和巨大型动脉瘤的临床效果。方法回顾性分析2017年4月至2021年2月郑州大学第一附属医院神经外科收治并实施颅内外高流量血管搭桥术的10例颈内动脉大型和巨大型动脉瘤患者的临床资料。10例患者共发现11个动脉瘤,其中8个位于颈内动脉海绵窦段,2个位于海绵窦及床突上段,1个位于交通段。10例患者中,8例行颅内外高流量血管搭桥+动脉瘤孤立术,2例行颅内外高流量血管搭桥+床突上段颈内动脉闭塞术或颈内动脉近心端阻断术;其中1例双侧动脉瘤患者仅处理破裂侧动脉瘤。术后桥血管的通畅情况采用头颈CT血管成像(CTA)评估;临床预后采用改良Rankin量表评分(mRS)评价。结果10例患者的手术均取得成功,术中吲哚菁绿荧光造影及数字减影血管造影显示血管吻合通畅率为100%。术后1例出现轻度失语、右侧肢体轻瘫;1例出现右眼视力明显下降;1例出现短暂性脑缺血发作。10患者的随访时间为(35.8±16.6)个月(11~60个月)。术后6个月随访时,除1例视力下降者无好转外,另外2例患者的并发症均明显恢复;mRS 0分8例,1分1例,2分1例。术后3~6个月行头颈CTA检查发现1例患者的桥血管闭塞,其余患者的桥血管均通畅。结论颅内外高流量血管搭桥术治疗颅内复杂动脉瘤的技术成功率和桥血管通畅率高,并发症较少,患者的预后较好。Objective To preliminarily investigate the clinical effect of extracranial-intracranial high flow bypass surgery for the treatment of large and giant aneurysms of internal carotid artery(ICA).Methods A retrospective analysis was conducted on the clinical data of 10 patients with large and giant ICA aneurysms who were admitted and treated by extracranial-intracranial high flow bypass surgery at the Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University from April 2017 to February 2021.A total of 11 aneurysms were identified in 10 patients,including 8 in the cavernous sinus segment,2 in the cavernous sinus and supraclinoid process segment,and 1 in the communicating segment.Among the 10 patients,8 cases underwent extracranial-intracranial high flow bypass plus aneurysm isolation;2 cases underwent extracranial-intracranial high flow bypass plus proximal occlusion of the parent artery,and 1 patient with bilateral aneurysms underwent treatment only on the ruptured side.The patency of the donor vessels was assessed by CT angiography(CTA).The clinical outcome was evaluated by the modified Rankin Scale(mRS).Results All operations were successful,and intra-operative indocyanine green fluorescence angiography and DSA showed that the patency rate of vascular anastomosis was 100%.After operation,1 case had mild aphasia and right limb paralysis,1 had decreased vision in the right eye,and 1 had TIA(transient ischemic attack).The follow-up time of 10 patients was 35.8±16.6 months(11-60 months).At 6 months after operation,except 1 case with visual impairment who had no recovery,the other 2 cases recovered significantly in terms of complications.The mRS score was 0 in 8 cases,1 in 1 case and 2 in 1 case.The CTA of 3-6 months post operation showed only 1 case of graft occlusion,and the graft vessel showed patency in other cases.Conclusion Extracranial-intracranial high-flow vascular bypass+aneurysm isolation or proximal occlusion of the parent artery for the treatment of intracranial complex aneurysms has

关 键 词：动脉瘤 颈内动脉 神经外科手术 治疗结果 高流量搭桥 

分 类 号：R651.12[医药卫生—外科学]