脑底异常血管网病合并颅内动脉瘤的外科治疗分析

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...

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

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 second stage or aneurysm clipping and ence-phalo-myo-synangiosis at one stage can be selected.