额外侧入路同期夹闭责任动脉瘤及对侧大脑中动脉M1段非责任动脉瘤的疗效  

Clinical effect of simultaneous clipping of responsible aneurysm and non-responsible aneurysm in M1 segment of the contralateral middle cerebral artery via the frontolateral approach

作　　者：蔡仕飞 侯长凯 李健[1] 杨宜璠 杨新宇[1] CAI Shifei;HOU Changkai;LI Jian;YANG Yifan;YANG Xinyu(Department of Neurosurgery,Tianjin Medical University General Hospital,Tianjin 300000,China)

机构地区：[1]天津医科大学总医院神经外科,天津300000

出　　处：《国际神经病学神经外科学杂志》2023年第3期1-5,共5页Journal of International Neurology and Neurosurgery

基　　金：国家自然科学基金面上项目(81571144);天津医科大学临床医学研究项目(2018kylc008)。

摘　　要：背景与目的 部分动脉瘤性蛛网膜下出血患者责任病灶对侧发现同时存在干预指征的颅内动脉瘤,尤其是对侧大脑中动脉M1段动脉瘤的同期治疗存在很大争论及挑战。该研究探讨单侧额外侧入路同期治疗责任病灶及对侧非责任病变的可行性、安全性及疗效。方法 2014年6月—2020年9月天津医科大学总医院神经外科共收治8例动脉瘤性蛛网膜下出血经单侧额外侧入路夹闭责任出血动脉瘤及对侧大脑中动脉M1段非责任动脉瘤患者,采用Fisher分级、Hunt-Hess分级、责任动脉瘤位置、对侧大脑中动脉瘤距离同侧M1段起点的长度、对侧大脑中动脉瘤朝向及大小、出院时改良Rankin量表(mRS)评分、出院时蒙特利尔认知评估量表(MoCA)评分等指标评估此手术方式的疗效。结果 8例患者共18个动脉瘤,其中16个是需要手术治疗的颅内动脉瘤,出血责任动脉瘤位于颈内动脉4例,前交通动脉2例,大脑中动脉2例。对侧大脑中动脉瘤距离同侧M1段起点的长度平均15.4 mm。需要处理的对侧大脑中动脉瘤平均3.4 mm×2.6 mm。术后复查头颅CTA见病灶远端颅内动脉走行自然,管壁光滑,病灶局部未见局限性狭窄或扩张。出院时有4例mRS评分为0;4例患者评分为1。出院时MoCA评分提示有2例患者存在轻度认知功能障碍(小于26分),余患者认知功能正常。结论 单侧额外侧入路治疗对侧非责任病变有很多优势且在技术上是可行的,为这类复杂病变的治疗提供了新思路。Background and objective Some patients with aneurysmal subarachnoid hemorrhage are found to have intracranial aneurysms with an indication for intervention on the contralateral side to the responsible lesion,and there are still controversies and challenges over the simultaneous treatment of aneurysms in the M1 segment of the contralateral middle cerebral artery.This study was conducted to investigate the feasibility,safety,and efficacy of the simultaneous treatment of responsible lesion and contralateral non-responsible lesion via the frontolateral approach.Methods A total of 8 patients with aneurysmal subarachnoid hemorrhage were admitted to Department of Neurosurgery,Tianjin Medical University,from June 2014 to September 2020,all of whom were treated with simultaneous clipping of the responsible aneurysm and the non-responsible aneurysm in M1 segment of the contralateral middle cerebral artery via the frontolateral approach.The clinical effect of this surgical procedure was evaluated based on the indicators such as Fisher grade,Hunt-Hess grade,location of the responsible aneurysm,distance between the aneurysm in the contralateral middle cerebral artery and the beginning of the ipsilateral M1 segment,orientation and size of the non-responsible aneurysm,modified Rankin Scale(mRS)score at discharge,and Montreal Cognitive Assessment(MoCA) score at discharge.Results There were a total of 18 aneurysms in 8 patients,among which 16 intracranial aneurysms required surgical treatment,and the responsible aneurysm was located in the internal carotid artery(4 patients),the anterior communicating artery(2 patients),or the middle cerebral artery(2 patients).The mean distance was 15.4 mm between the aneurysm in the contralateral middle cerebral artery and the beginning of the ipsilateral M1 segment,and the aneurysms requiring treatment in the contralateral middle cerebral artery had a mean size of 3.4 mm×2.6 mm.Postoperative cerebrovascular CTA showed that the intracranial artery at the distal end of the lesion had a normal s

关 键 词：颅内多发动脉瘤 额外侧入路 大脑中动脉 

分 类 号：R651.12[医药卫生—外科学]