以脑缺血为首发症状的前循环动脉瘤临床特点与治疗  

Treatment of anterior circulation aneurysm presenting with cerebral ischemia

作　　者：王杏东 佟小光[2] WANG Xingdong;TONG Xiaoguang(Clinical College of Neurology,Neurosurgery and Neurorehabilitation,Tianjin Medical University,6 Jizhao Road,Jinnan District,Tianjin 300350,China)

机构地区：[1]扬州大学附属苏北人民医院神经外科,扬州225001 [2]天津医科大学神经内外科及神经康复临床学院神经外科,环湖医院神经外科

出　　处：《中国神经精神疾病杂志》2023年第6期345-350,共6页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的探讨以脑缺血为首发症状的前循环动脉瘤临床特点及治疗策略。方法回顾性分析2016年9月至2021年12月收治的10例以脑缺血为首发症状前循环动脉瘤患者的临床资料。结果10例患者中,以短暂性脑缺血发作(transient ischemic attack,TIA)为首发症状者4例,以缺血性卒中为首发症状者6例;颈内动脉动脉瘤3例,大脑中动脉瘤7例;巨大动脉瘤5例,大动脉瘤4例,小动脉瘤1例;单纯囊状动脉瘤3例,囊状动脉瘤合并血栓形成3例,夹层动脉瘤4例;治疗方式上,支架辅助弹簧圈栓塞1例,显微手术夹闭1例,动脉瘤切除3例,其中1例动脉瘤切除后原位吻合,2例辅以颞浅动脉-大脑中动脉(STA-MCA)搭桥术,动脉瘤孤立联合STA-MCA搭桥术3例,近端阻断联合颈外动脉-桡动脉-大脑中动脉(ECA-RA-MCA)高流量搭桥1例,颈内动脉缩窄联合STA-MCA搭桥1例。术后除1例患者出现同侧基底节小范围梗死致对侧肌力下降外,其他患者未出现新的神经功能障碍。术后复查8例动脉瘤消失,2例动脉瘤缩小。术后随访9~72个月,平均35.3个月,随访期间无蛛网膜下腔出血或新发脑梗死,无动脉瘤复发、扩大。结论前循环单纯宽颈或合并血栓形成的囊状动脉瘤、夹层动脉瘤,均可能出现远端血管栓塞致脑缺血发作,明确诊断后通过对动脉瘤及血流的细致分析,制定个性化的手术方案,可取得良好的治疗效果。Objective To investigate the clinical characteristics and treatment strategy of anterior circulation aneurysm presenting with cerebral ischemia.Methods The clinical data of 10 patients with anterior circulation aneurysm presenting with cerebral ischemia admitted from September 2016 to December 2021 were retrospectively analyzed.Results In total,4 cases were presented with transient ischemic attack(TIA)and 6 cases were presented with ischemic stroke.Treated aneurysms were located at the internal carotid artery(ICA)in 3 patients and postbifurcation middle cerebral artery(MCA)in 9 patients.A total of 3 aneurysms were saccular,3 were saccular aneurysms combined with thrombosis,and 4 were dissecting,including 5 giant aneurysms,4 large aneurysms and 1 microaneurysm.Stent assisted aneurysm embolization was performed in 1 case,aneurysm clipping in 1 case,aneurysm resection in 3 cases,in which 1 case was performed with aneurysm resection with in-situ anastomosis and 2 cases combined with superficial temporal artery-middle cerebral artery(STA-MCA)bypass,aneurysm isolated combined with STA-MCA bypass in 3 cases,proximal occlusion combined with external carotid artery-radial artery-middle cerebral artery(ECA-RA-MCA)high-flow bypass was performed in 1 case,and internal carotid artery constriction combined with STA-MCA bypass was performed in 1 case.No new neurological dysfunction was found in other patients except 1 patient with a small area infarction of the ipsilateral basal ganglia resulting in decreased contralateral muscle strength.In the postoperative review,aneurysms disappeared in 8 cases and aneurysms shrank in 2 cases.All patients were followed up for 9 to 72 months,with an average of 35.3 months.No new cerebral infarction occurred in all patients,no subarachnoid hemorrhage,and no recurrence or enlargement of aneurysms during the follow-up.Conclusion Saccular aneurysms with wide neck or thrombosis and dissected aneurysms of the anterior circulation may result in cerebral ischemic attack caused by distal vascular emb

关 键 词：颅内动脉瘤 前循环 脑缺血 血栓 脑血管重建术 外科手术 

分 类 号：R651[医药卫生—外科学]