脑底异常血管网病合并颅内动脉瘤的外科治疗分析  

Outcomes of individualized surgical treatment of patients with moyamoya disease associated with intracranial aneurysms

作　　者：徐建国 朱巍巍[1] 李吻[1] 尤万春[1] 孙晓欧[1] 陈罡[1] 王中[1] XU Jian-guo;ZHU Wei-wei;LI Wen;YOU Wan-chun;SUN Xiao-ou;CHEN Gang;WANG Zhong(Department of Neurosurgery,The First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院神经外科,江苏苏州215006

出　　处：《中国临床神经外科杂志》2023年第5期296-299,共4页Chinese Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(81873741)。

摘　　要：目的探讨脑底异常血管网病合并颅内动脉瘤的外科治疗方式及其疗效。方法回顾性分析2016年1月至2019年12月收治的18例脑底异常血管网病合并颅内动脉瘤的临床资料。根据病人的具体情况选择个体化治疗方案。结果10例非血流相关性破裂动脉瘤中,5例行动脉瘤夹闭+颞肌贴敷术,4例行动脉瘤栓塞术,1例行动脉瘤栓塞+二期单侧颞浅动脉-大脑中动脉(STA-MCA)分流术;3例烟雾血管破裂出血中,1例行血肿清除+脑室外引流术,1例保守治疗,1例行STA-MCA分流术;5例未出血病人中,1例行STA-MCA分流+动脉瘤夹闭术,2例行STA-MCA分流术,2例行动脉瘤栓塞+STA-MCA分流术。围手术期死亡1例;存活17位出院后随访1~5年,1例保守治疗2年因再出血死亡;1例发生颅内再出血。16例存活病人末次随访改良Rankin量表评分0分10例,1分3例,2分2例,4分1例(再出血病人)。结论脑底异常血管网病合并颅内动脉瘤的病人,可以根据是否有出血症状及所合并的是否为血流相关性动脉瘤,采取相应的手术方式。存在血流相关性动脉瘤,但没有颅内出血的病人,可以行单纯STA-MCA分流术,而不需要处理动脉瘤。存在非血流相关性动脉瘤的病人,则首选介入治疗动脉瘤,二期行STA-MCA分流术,亦可以选择同期行动脉瘤夹闭+STA-MCA分流术;对急诊出血病人,可以选择介入栓塞动脉瘤+二期STAMCA分流术或同期行动脉瘤夹闭+颞肌贴敷术。Objective To investigate the outcomes of individualized surgical treatment of patients with moyamoya disease(MMD)complicated with intracranial aneurysms(IAs).Methods The clinical data of 18 patients with MMD complicated with IAs who were admitted to our hospital from January 2016 to December 2019 were retrospectively analyzed.Results Of 10 patients with non-flow related ruptured aneurysms,5 underwent aneurysm clipping and ence-phalo-myo-synangiosis,4 underwent aneurysm embolization,and 1 underwent aneurysm embolization and unilateral superficial temporal arterion-middle cerebral artery(STA-MCA)bypass.Of 3 patients with cerebral hemorrhage due to the rupture of smog-like vessels,1 patient received hematoma removal and external ventricular drainage,1 received conservative treatment,and 1 received STA-MCA bypass.Of 5 patients without intracranial hemorrhage,1 underwent STA-MCA bypass and aneurysm clipping,2 underwent STA-MCA bypass,and 2 underwent aneurysm embolization and STA-MCA bypass.One patient died during the perioperative period.The follow-up of 17 survivors ranged from 1 year to 5 years after discharge,and 1 patient died of rebleeding after 2 years of conservative treatment.Intracranial rehemorrhage occurred in 1 patient.At the last follow-up of 16 surviving patients,a mRS score of 0 was achieved in 10 patients,a score of 1 in 3,a score of 2 in 2,and a score of 4 in 1.Conclusions For patients with MMD complicated with IAs,appropriate surgical procedures can be taken according to whether there are bleeding symptoms and whether the complicated aneurysms are flow-related aneurysms.Patients with flow-related aneurysms,but without intracranial hemorrhage,can be treated with STA-MCA bypass alone without aneurysm management.For patients with non flow-related aneurysms,interventional treatment is preferred and STA-MCA bypass is performed at the second stage,or aneurysm clipping plus STA-MCA bypass is performed at one stage.For patients with emergency bleeding,interventional embolization and STA MCA bypass at the sec

关 键 词：脑底异常血管网病 烟雾病 颅内动脉瘤 外科治疗 

分 类 号：R749.3[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]