颅内-外血管重建联合动脉瘤孤立术治疗颅内巨大型动脉瘤的疗效  

Efficacy of intracranial-extracranial revascularization combined with aneurysm trapping in the treatmentofgiant intracranial aneurysms

作　　者：石志勇 喻乐保 张玉华[1] 王毅[1] 王健 杨咏波 张东[2] 杭春华[1] Shi Zhiyong;Yu Lebao;Zhang Yuhud;Wang Yi;Wang Jian;Yang Yongbo;Zhang Dong;Hang Chunhud(Department of Neurosurgery,Nanjing Drum Tower Hospital Affiliated to Nanjing University,Nanjing 210008,China;Department of Neurosurgery,Bejing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Changzhou Second Hospital,Nanjing Medical University,Changzhou 213004,Chin)

机构地区：[1]南京大学附属鼓楼医院神经外科,南京210008 [2]首都医科大学附属北京天坛医院神经外科,北京100070 [3]南京医科大学附属常州第二人民医院神经外科,常州213004

出　　处：《中华神经外科杂志》2022年第12期1189-1193,共5页Chinese Journal of Neurosurgery

基　　金：国家重点研发计划(2021YFC2500502)。

摘　　要：目的观察颅内-外血管重建术联合动脉瘤孤立术治疗颅内巨大型动脉瘤的安全性及临床疗效。方法 2016年1月至2021年10月南京大学附属鼓楼医院神经外科(6例)及首都医科大学附属北京天坛医院神经外科(12例)采用颅内-外血管重建术联合动脉瘤孤立术治疗18例颅内巨大型动脉瘤患者。其中颈外动脉-桡动脉-大脑中动脉(MCA)M2段吻合6例、颞浅动脉-桡动脉-MCA M2段吻合5例, 颞浅动脉-MCA M3/4段吻合6例, 颞浅动脉-桡动脉-大脑后动脉P3段吻合1例。回顾性分析患者的手术相关发症及疗效。结果所有患者均顺利完成手术, 术中均未发生颅内动脉瘤破裂;术后影像学检查显示颅内动脉瘤均消失。术后1周内共有5例患者发生手术相关并发症, 4例为脑梗死, 其中1例因急性桥血管损伤致大面积脑梗死;1例为动眼神经麻痹, 但MRI未见颅内新发梗死灶。术后中位随访时间为36个月(3~62个月), 18例患者均未见颅内动脉瘤复发;随访末期, 改良Rankin量表评分0~1分15例, 2~3分2例, 4~5分1例。结论颅内-外血管重建术联合动脉瘤孤立术是治疗颅内巨大型动脉瘤的重要方式, 术后疗效较好, 脑梗死是主要的手术并发症。Objective To investigate the safety and clinical efficacy of extracranial-intracranial(EC-IC)revascularization combined with aneurysm trapping in the treatment of giant intracranial aneurysm(GIAs).MethodsA retrospective study was conducted on 18 cases of GIAs who underwent EC-IC bypass and aneurysm trapping at the Department of Neurosurgery,Nanjing Drum Tower Hospital Affiliated to Nanjing University(6 cases)and the Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University(12 cases)from January 2016 to October 2021.Among them,there were 6 cases of external carotid artery(ECA)-radial artery(RA)-middle cerebral artery(MCA)M2 segment anastomosis,5 cases of superficial temporal artery(STA)-RA-MCA M2 segment anastomosis,6 cases of STA-MCA M3/4 segment anastomosis,and 1 case of STA-RA-posterior cerebral artery(PCA)P3 segment anastomosis.The surgical-related complications and efficacy of the patients were retrospectively analyzed.ResultsAll patients successfully underwent the operation,and no intracranial aneurysm rupture occurred during the operation.Postoperative imaging examination showed that the intracranial aneurysm disappeared.A total of 5 patients had surgery-related complications within 1 week after the operation,including 4 cases of cerebral infarction,of which 1 case was massive cerebral infarction due to acute bypass graft injury.There was 1 case of oculomotor nerve palsy,while MRI showed no intracranial newly-developed infarction.The median followup time after operation was 36 months(3-62 months),and no recurrence of intracranial aneurysm was found in 18 patients.At the latest follow-up,the modified Rankin scale score was 0-1 in 15 cases,2-3 in 2 cases,and 4-5 in 1 case.Conclusion EC-IC bypass combined with aneurysm trapping is an important option to treat GIAs and postoperative brain infraction is the major complication.

关 键 词：颅内动脉瘤 脑血管重建术 治疗结果 

分 类 号：R651.12[医药卫生—外科学]