颅内外血管搭桥治疗复杂动脉瘤及搭桥血管闭塞的防治

目的 探讨颅内外血管搭桥技术在复杂动脉瘤治疗中的应用和移植血管闭塞的原因.方法 回顾分析2006年11月至2008年11月以颅内外血管搭桥治疗的20例颅内复杂动脉瘤,并总结大隐静脉闭塞的原因.其中男性8例,女性12例,年龄27～65岁,平均54.5岁.动脉瘤位于海绵窦内13例,床突旁动脉瘤4例,床突上动脉瘤2例,基底动脉干动脉瘤1例;动脉瘤＜15 mm者4例,15～25 mm者12例,＞25 mm者4例.结果 1例术中出现血管闭塞,1例术后出现血管闭塞,出院时格拉斯哥预后评分(GOS)4～5分者17例(17/20),3分(重残)2例(2/20),1分(死亡)1例(1/20).19例生存患者术后6个月随访GOS评分4～5分者18例(18/19),3分(重残)1例(1/19).结论 颅内外血管搭桥技术治疗颅内复杂动脉瘤是有效、安全的,机械因素和血流动力学因素是移植血管闭塞最主要的原因,移植血管的长期通畅率还有待进一步观察.

Abstract：

Objectives To study the revascularization techniques in the treatment of intracranial complex aneurysms and occlusive reasons of bypass vessel. Methods The 20 complex intracranial aneurysms who underwent saphenous bypass treatment from November 2006 to November 2008 were retrospectively analyzed and the occlusive reasons were studied. Of the 20 patients, 12 were female and 8 were male, mean age was 54.5 years (ranged 27-65 years). The distribution of the lesions inclued 13 cavenous sinus aneurysms, 4 paraclinoidal aneurysms, 2 supraclinoidal aneurysms, and 1 basilar trunk aneurysm. Four aneurysms were giant (diameter ＞25 mm), 12 aneurysms were large( 15-25 mm), and 4 aneurysms were medium( 10-15 mm) size. Results One saphenous vein was occlused intraoperativly and one saphenous vein was occlused postoperativly. At discharge, 18 out of the 20 patients had Glasgow Outcome Scale (GOS) score of 4 orS, 2 patients had score of 3, and 1 patient had score of 1. At 6 months follow up, 18 of 19 survivors had GOS score of : or 5 and 1 patient had score of 3. Conclusions Extracranial-intracranial revascularization technique is a safe and effective method in the treatment of complex aneurysms. Mechanical and hemodynamic factors are two leading reasons for occlusion of bypass vessels. Long-term bypass vessels patent rate still needs further observation.

Extracranial-intracranial revascularization techniques in the treatment of complex aneurysms and prevention and management of occlusion of bypass vessels

Objectives To study the revascularization techniques in the treatment of intracranial complex aneurysms and occlusive reasons of bypass vessel. Methods The 20 complex intracranial aneurysms who underwent saphenous bypass treatment from November 2006 to November 2008 were retrospectively analyzed and the occlusive reasons were studied. Of the 20 patients, 12 were female and 8 were male, mean age was 54.5 years (ranged 27-65 years). The distribution of the lesions inclued 13 cavenous sinus aneurysms, 4 paraclinoidal aneurysms, 2 supraclinoidal aneurysms, and 1 basilar trunk aneurysm. Four aneurysms were giant (diameter ＞25 mm), 12 aneurysms were large( 15-25 mm), and 4 aneurysms were medium( 10-15 mm) size. Results One saphenous vein was occlused intraoperativly and one saphenous vein was occlused postoperativly. At discharge, 18 out of the 20 patients had Glasgow Outcome Scale (GOS) score of 4 orS, 2 patients had score of 3, and 1 patient had score of 1. At 6 months follow up, 18 of 19 survivors had GOS score of : or 5 and 1 patient had score of 3. Conclusions Extracranial-intracranial revascularization technique is a safe and effective method in the treatment of complex aneurysms. Mechanical and hemodynamic factors are two leading reasons for occlusion of bypass vessels. Long-term bypass vessels patent rate still needs further observation.