眶上锁孔入路手术治疗前交通动脉动脉瘤

目的：探讨前交通动脉（ACoA）动脉瘤经眶上锁孔入路手术夹闭的手术技术、安全性和相对适应证。方法：总结27例经眉弓眶上锁孔入路手术治疗的ACoA动脉瘤临床资料，着重阐述手术方法、术中动脉瘤破裂处理及手术适应证。结果：27例动脉瘤全部一次手术夹闭成功，但其中有5例术中动脉瘤破裂，3例合并脑积水者行脑室一腹腔分流术，1例死亡。27例患者均未出现手术入路相关并发症。19例数字减影血管造影或CT血管造影随访显示夹闭良好。结论：眶上锁孔入路显微外科手术是治疗ACoA动脉瘤的一种有效、安全的微创方法。     

眼动脉瘤的显微外科治疗

目的探讨眼动脉段颈内动脉瘤的显微手术适应症和手术技巧。方法采用硬膜内-外入路显微手术夹闭眼动脉段动脉瘤12例患者。结果本组患者无手术死亡,术后均经血管造影证实动脉瘤已全部夹闭。结论显微外科手术治疗眼动脉段颈内动脉瘤是安全可靠的治疗方法。     

颈内动脉床突段微小动脉瘤治疗体会

目的 探讨颈内动脉床突段微小动脉瘤的治疗方法.方法 回顾性分析经临床和影像学方法确诊的18例颈内动脉床突段微小动脉瘤患者资料,其中颈内动脉-眼动脉瘤患者4例,3例行血管内治疗,1例行开颅夹闭;颈内动脉后交通动脉瘤患者10例,3例行血管内治疗,7例行开颅夹闭;颈内动脉脉络膜前动脉瘤患者3例,1例行血管内治疗,2例行开颅夹闭;1例颈内动脉分叉部动脉瘤患者行开颅夹闭.结果 1例颈内动脉-眼动脉瘤患者行弹簧圈栓塞治疗后破裂出血,死亡;1例行支架辅助弹簧圈栓塞治疗颈内动脉后交通动脉瘤患者术中破裂,疏松填塞,术后再次破裂出血,死亡;1例行单纯弹簧圈栓塞治疗颈内动脉后交通动脉瘤患者术中弹簧圈逸出,后行开颅夹闭,恢复好;其余病例预后均良好.结论 颈内动脉床突段微小动脉瘤中眼动脉瘤以支架辅助弹簧圈疏松栓塞治疗为宜,开颅夹闭是治疗颈内动脉床突上段微小动脉瘤的首选.     

复发性颅内动脉瘤的治疗探讨

目的 探讨复发性颅内动脉瘤的复发机制及治疗方法.方法 对我科1997～2004年间行动脉瘤夹闭术或血管内介入治疗后复发的18例动脉瘤患者(前循环动脉瘤13例,后循环动脉瘤5例1的临床表现、影像学资料进行综合分析,建立个体化治疗方案,其中15例患者行再次血管内介入治疗,4例宽颈动脉瘤辅以颅内支架,3例行手术夹闭.结果 15例行血管内介入治疗患者均栓塞良好.3例手术完全夹闭.术后1例死亡,2例偏瘫,15例恢复满意.结论 针对不同情况的复发性动脉瘤患者实施个体化治疗方案,分别进行手术夹闭、血管内介入或联合治疗可提高患者生存质量.     

开颅手术联合血管内技术一期治疗颅内血管性疾病

目的探讨开颅手术联合血管内技术一期治疗颅内血管病的方法、适应症、条件及疗效。方法对收治的2例复杂颅内血管性疾病患者行一期开颅手术联合血管内治疗,并结合相关文献对其临床资料进行分析。结果本组1例动静脉畸形患者栓塞后,同时行开颅手术彻底切除畸形血管团;1例夹层动脉瘤患者开颅夹闭成形后,置入支架贴壁确切。2例患者术后均恢复良好。结论开颅手术联合血管内技术一期治疗颅内血管性疾病的方法具备一定的可行性和有效性。     

开颅手术和血管内栓塞治疗颅内动脉瘤的疗效比较

目的对开颅夹闭和血管内栓塞治疗颅内动脉瘤的疗效进行比较。方法回顾性分析50例颅内动脉瘤患者行手术治疗,其中开颅夹闭组24例,血管内栓塞组26例,对两组的疗效和并发症进行比较分析。结果开颅夹闭组:24例成功夹闭瘤颈,手术相关并发症6例。随访2年,复查脑血管造影,24例中有2例夹闭不全。血管内栓塞组:成功栓塞24例,2例多发动脉瘤患者一侧成功栓塞,遗留另一侧未栓塞,血管内栓塞相关并发症5例。随访1月～2年,无瘤体复发或再发。结论开颅夹闭和血管内栓塞都是治疗颅内动脉瘤的有效方法,临床上应视病人瘤体特点等情况选择手术方式。     

小脑前下动脉瘤五例报告

目的探讨小脑前下动脉（AICA）动脉瘤的临床特征、治疗方式的选择及操作技巧。方法回顾性分析5例AICA动脉瘤的临床资料。结果AICA远端囊性动脉瘤3例，其中2例位于内听道口，1例化于小脑绒球腹侧、面听神经背侧，并伴有同侧小脑半球小型隐匿性血管畸形，术中借助神经内镜发现动脉瘤，3例均行手术夹闭，并于术后住院期间行脑血管造影复查，夹闭满意；AICA近端囊性动脉瘤2例，均采用血管内介入治疗。患者预后优4例，良1例。结论AICA远端动脉瘤宜首选手术夹闭，术是辅助神经内镜有助于提高显微手术效果；AICA近端动脉瘤宜首选血管内介入治疗。     

破裂性前交通动脉瘤急性期血管内治疗和手术夹闭对照研究

目的：比较破裂性前交通动脉瘤急性期微弹簧圈栓塞和手术夹闭的疗效。方法回顾性分析122例前交通动脉瘤患者的临床资料，按治疗方法分为血管内治疗组和手术夹闭组；比较2组1个月内病死率和3个月生活能力评分。结果血管内治疗组79例，死亡3例，手术夹闭组43例，死亡5例，血管内治疗组与手术夹闭组病死率比较差异无统计学意义（χ2＝2.786，P＞0.05）。存活患者发病后3个月Barthel指数作生活量表（ADL ）评分，血管内治疗组ADL I级68例，手术夹闭组29例，2组比较差异有统计学意义（χ2＝5.934，P＜0.05）。结论破裂性前交通动脉瘤急性期微弹簧圈栓塞治疗可提高患者远期生活质量。     

颅内多发动脉瘤的治疗(附76例资料分析)

目的 探讨颅内多发动脉瘤(MIA)的手术时机和手术方法的选择.方法 本组76例MIA中,同时治疗责任和非责任动脉瘤52例.仅经翼点开颅显微手术夹闭34例,其中一次性夹闭32例,分次夹闭2例;行血管内栓塞,一次性栓塞11例;栓塞结合夹闭治疗7例.仅治疗责任病灶24例.结果 手术夹闭的34例(68个)动脉瘤经DSA或CTA复查,63个夹闭完全,2个瘤颈残留,3个包裹.血管内栓塞的11例25个动脉瘤经DSA复查,22例栓塞完伞,3个动脉瘤栓塞不完全.栓塞加夹闭的7例15个动脉瘤消失.结论 MIA治疗应个体化分析,采用夹闭手术与血管内栓塞相结合,尽量一期治疗,从而降低治疗风险获得良好疗效.     

颅内多发性动脉瘤的显微手术及血管内治疗

目的探讨颅内多发性动脉瘤的临床特点及其治疗。方法回顾分析我院2001年2月至2011年8月收治的58例颅内多发性动脉瘤患者的临床资料。显微手术夹闭49例,血管内栓塞治疗7例,手术联合栓塞治疗2例。结果 58例病人中,恢复良好45例,轻残7例,重残3例,死亡3例。结论显微手术夹闭及血管内栓塞均是治疗颅内多发性动脉瘤的可靠且有效的方法。根据患者的病情,选择合适的治疗方案,可以提高颅内动脉瘤患者的疗效。     

Malformation vasculaire cérébrale découverte dans le bilan pré-thrombolyse d’un infarctus cérébral. Impact sur la décision thérapeutique

Intravenous recombinant tissue plasminogen activator for acute ischemic stroke is contraindicated in patients harboring an asymptomatic intracranial vascular malformation, whether it is incidentally discovered at the time of the initial cerebral imaging or previously known. Because thrombolysis is associated with a risk of serious intracerebral hemorrhage, it is theoretically possible that this treatment increases the risk of bleeding or rupture of these malformations. However, this risk seems very low in clinical practice. We report two cases, one with a probable brainstem cavernous malformation treated with alteplase for a supratentorial ischemic stroke who developed just after treatment a fatal brainstem hemorrhage, and another one with asymptomatic dural arteriovenous fistula, treated by endovascular thrombectomy solely. This approach was safe and effective, and the patient had an endovascular embolization of the fistula one month later as it became symptomatic. Based on the literature, we discuss the bleeding risk of asymptomatic intracranial vascular malformations in acute ischemic stroke patients treated with alteplase, depending on the type of malformation (intracranial aneurysm, arteriovenous and cavernous malformation or fistula), and the alternative therapeutic options.     

False aneurysm of cavernous carotid artery and carotid cavernous fistula: complications following transsphenoidal surgery

We present two cases of carotid injury during transsphenoidal surgery for pituitary adenoma. While in one of the cases it resulted in the formation of a false aneurysm of cavernous carotid artery, in the other patient, a carotid cavernous fistula (CCF) formed. The false aneurysm was managed by surgical trapping and the patient had an uneventful recovery. The CCF was initially managed with balloon embolization. The balloon got deflated and resulted in a false aneurysm with persistent CCF. This was occluded with Guglielmi Detachable Coils (GDC). The management options are discussed and relevant literature is reviewed. We emphasize the importance of an early cerebral angiography to know the status of the injured carotid artery and formation of false aneurysm / fistula.     

覆膜支架治疗颈内动脉假性动脉瘤合并海绵窦瘘一例报告并文献复习

目的 报告1例使用覆膜支架治愈颈内动脉假性动脉瘤合并颈内动脉海绵窦瘘(CCF).方法 患者因外伤后右侧上睑下垂、眼肌麻痹、眼球突出、结膜水肿2周来院,血管造影显示:右侧颈内动脉海绵窦假性动脉瘤合并CCF,患者接受覆膜支架介入治疗.结果 Jostent球囊扩张支架置于动脉瘤颈部,经反复扩张后动脉瘤和CCF均不显影.术后患者恢复良好.结论 尽管Jostent覆膜支架用于颅内血管病的治疗仍然存在一些问题,但为颈内动脉海绵窦动脉瘤和CCF的介入治疗提供了一种有效的方法 .     

Incidence of vascular malformations in spontaneous intra-cerebral haemorrhage in children

Aim To assess the incidence of vascular malformations in children presenting with non-traumatic intra-cerebral haemorrhage and outline the need for radiological investigations. Materials and methods Between 1993 and 2002, 26 children presented with spontaneous intra-cerebral haemorrhage at a mean age of 26 months (range 1–192 months). Results Twenty-two children had, as first treatment, surgical removal of the haematoma and any malformation found. One patient with no evidence of vascular malformation had conservative treatment, two had embolisation and one had stereotactic radiosurgery of arteriovenous malformations (AVMs). The diagnosis of vascular malformation was confirmed histologically and/or radiologically in 16 (61%) patients. Of these 16 patients, 7 were AVMs, 1 thrombosed middle cerebral artery (MCA) aneurysm, 1 cavernous angioma, 6 aggregates of abnormal vessels, 1 vein of Galen aneurysm. Pre-operatively, 12 patients had magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) and 7 were positive for vascular malformation (1 false positive) with no false negatives. Digital subtraction angiography (DSA) was performed pre-operatively in 7 patients, 4 were positive with no false negatives. There were no re-bleeds at the follow-up period. Five (19%) patients died from the haemorrhage, 7 (27%) had severe neurological deficit and 14 (54%) had no neurological deficit. Residual malformation after surgery requiring additional treatment was found in 3 (16%) patients. All patients with confirmed malformations were followed-up with DSA. Conclusion MRI/MRA has high sensitivity and specificity in identifying vascular malformations in children presenting acutely with spontaneous intra-cerebral haemorrhage. This may prove useful when pre-operative DSA is not promptly available. After acute clot evacuation, there is high incidence of residual malformation and such patients should be followed-up with DSA. This paper was presented at the XX Congress of the European Society for Pediatric Neurosurgery, Martinique, French Antilles, March 3–9, 2006.     

A case of CNS aspergillosis developing orbital apex syndrome and causing mycotic aneurysm and the subsequent cerebral infarction]

A 79-year-old woman, with no immune deficit, had presented progressive visual disturbance, diplopia and ptosis of her left eye over 2 weeks. T1-weighted MR images with gadolinium showed a heterogeneously enhanced lesion extending from the left orbital apex along the optic nerve to the cavernous sinus. Although we could not detect fungus by a transsphenoidal biopsy, we suspected fungal infection because of high level of galactomanan antigen in serum. Despite antifungal chemotherapy, her symptoms did not improve. CT image on day 40 showed an aneurysm in the left internal carotid artery, on day 43 cerebral infarction in the left internal carotid artery distribution and on day 45 she died. Autopsy disclosed that aspergillus hyphae invaded the left sphenoid sinus, cavernous sinus and wall of the aneurysm. In this case, fungal infection in the frontal skull base including orbital apex caused mycotic aneurysm in the intracavernous portion of the left internal carotid artery. Skull base aspergillosis presenting orbital apex syndrome is itself rare and in addition, the occurrence of cerebral infarction in the mycotic aneurysm has hardly been reported. We should have cerebrovascular disease in mind as a complication of CNS aspergillosis.     

A case of Wyburn-Mason syndrome

A extremely rare case of unilateral retinocephalic vascular malformation (Wyburn-Mason syndrome) was reported. A 5 year-old girl was seen to a ophthalmologist complaining of exophthalmus of her left eye after trauma on her face for the past 2 months. On ophthalmologic examinations, retinal arteriovenous malformation was recognized in her left eye and she was referred to neurosurgical service for the evaluation on occurrence of traumatic carotid cavernous fistula. Plain CT did not show any abnormality but enhanced CT revealed an abnormally enhanced lesion in the thalamus and basal ganglia and along to the left optic nerve. Left carotid angiography and vertebral angiography revealed a huge arteriovenous malformation in the left thalamus and basal ganglia extending to the left orbita. The arteriovenous malformation was fed from the C3 segment of the carotid artery, anterior, middle and posterior cerebral arteries, and drained to the internal cerebral vein and basal vein. The intraorbital part of the malformation was mainly fed from the external cerebral artery. She was diagnosed as Wyburn-Mason syndrome. We stressed in the paper that enhanced CT was useful for the diagnosis of the Wyburn-Mason syndrome.     

Anterior communicating artery aneurysm associated with an infraoptic course of anterior cerebral artery and rare variant of the persistent trigeminal artery: a case report and literature review

Infraoptic course of the precommunicating segment of the anterior cerebral artery (A1) is a rare anomaly. Furthermore, the presence of this anomaly associated with persistent trigeminal artery variant has been reported in the literature only once. We present a patient who had infraoptic course of A1 associated with an ipsilateral persistent trigeminal artery variant arising from the right internal carotid artery with no apparent connection to the basilar artery. The persistent trigeminal artery variant supplied to the right posteroinferior cerebellar artery territory. The patient also had hypoplastic left vertebral artery, superior cerebellar arteries originating from posterior cerebellar arteries bilaterally, and a bilobed aneurysm of the anterior communicating artery. The aneurysm was clipped and the infraoptic course was verified during the surgery. The post-operative course was uneventful and a follow-up arteriogram on the 7th postoperative day revealed successful obliteration of the aneurysm.We reviewed the literature with respect to presentation, associated vascular anomalies, imaging, associated cerebral aneurysms and other cerebral abnormalities, and treatment of the associated aneurysms. A discussion of the embryogenesis of this rare anomaly is also provided.     

Carotid agenesis with intercavernous anastomosis

Agenesis of internal carotid artery (ICA) is rare. Association of agenesis with abnormal arterial communication between the cavernous segment of the carotid arteries is extremely rare. We present a case of a middle-aged woman who presented with sudden onset severe holocranial headache. She was investigated and diagnosed to have sub-arachnoid hemorrhage on CT scan. Digital Subtraction Angiogram revealed absent right internal carotid artery. The right middle cerebral artery received blood supply from an incidentally detected intercavernous anastomosis from the left internal carotid artery. No aneurysm, arteriovenous malformation or any other vascular abnormality was detected. The patient was managed conservatively. She has been asymptomatic for five years on follow up.     

Ophthalmic artery fed by posterior communicating artery after trapping of the internal carotid artery

The authors report a 50-year-old man with a ruptured large carotid-ophthalmic aneurysm on the right side and an unruptured anterior communicating artery (A Com) aneurysm. The A Comm aneurysm was clipped and the carotid-ophthalmic aneurysm was managed by combining internal carotid artery (ICA) trapping with an interposed radial artery graft from the external carotid artery (ECA) to the middle cerebral artery (MCA). The patient had an uncomplicated postoperative recovery. Postoperative carotid angiography demonstrated no aneurysms and excellent flow through the bypass graft. Postoperative vertebral angiography showed the right ophthalmic artery to be fed by the posterior communicating artery. It is speculated that collateral circulation from the angular artery of the ECA to the ophthalmic artery did not develop because of high flow graft from the ECA to MCA and ICA trapping.     

联合自膨胀颅内支架和生物活性弹簧圈栓塞1例海绵窦宽颈动脉瘤

目的报道采用自膨胀专用颅内支架Neuroform和生物活性弹簧圈Matrix栓塞1例宽颈海绵窦动脉瘤的经验.方法对一女性48岁多发性脑动脉瘤病人,在栓塞其破裂的前交通动脉瘤后5个月,采用国际上第1个专用颅内支架Neuroform和第1种具有生物活性的弹簧圈Matrix栓塞另一伴发的宽颈海绵窦动脉瘤.结果支架成功置入载瘤动脉的瘤颈处,并经插入支架网眼内的微导管在动脉瘤内填入3个Matrix电解脱弹簧圈,动脉瘤闭塞95%以上,载瘤动脉通畅.病人无神经功能症状,弥散加权MR未见脑缺血灶,MRA和TCD未见脑血管痉挛,术后5 d出院.结论Neuroform颅内支架使用方便、安全,适用于颅内宽颈动脉瘤的支架辅助弹簧圈栓塞,特别适用于迂曲的脑血管.