复杂大脑中动脉动脉瘤1例

颅内复杂动脉瘤无论是血管内栓塞还是手术夹闭难度均较大。最近我科采用支架分割血管内栓塞术治疗复杂大脑中动脉动脉瘤1例,现报道如下。1病例报告患者男性,58岁,因“突发头痛,头晕1d,反应迟钝半天”人院。入院查体：BPl67／85mmHg,嗜睡,GCS13分;两侧瞳孔等大等圆,直径约2．0mm,对光反射灵敏;呼唤能应,能简单遵医嘱运动;Hunt—Hess分级3级,颈抵抗明显,四肢肌力v级,两侧巴氏征阴性。     

巨大大脑中动脉动脉瘤夹闭1例

目的探讨巨大大腻中动脉（MCA）动脉瘤的诊疗经验。方法州顺性分析1例巨大MCA动脉瘤病人的临床资料,经开颅手术切除瘤体后夹闭瘤颈,并行去骨瓣减压,结合文献进行分析。结果术后7dCTA硅示动脉瘤无残留,左侧MCA末梢显影很好。术后2周GOS评分为5分。术后3个月行颅骨修补术．头部CT硅示无明显脑缺血灶。随访2年,病人恢复良好,能正常生活及Ij作。结论术前充分评估瘤体和瘤颈形态,术中切除占位性瘤体后重塑瘤颈再妥善央闭,可使巨大MCA动脉瘤的手术央闭获得良好疗效。     

大脑中动脉动脉瘤的显微手术治疗

目的总结显微外科手术处理大脑中动脉动脉瘤的经验。方法1998年1月～2006年1月共手术治疗大脑中动脉动脉瘤36例，男19例，女17例。年龄12～65岁（平均41岁）。36例共计38个大脑中动脉动脉瘤，动脉瘤大小3～60mm，其中3～7mm9个，8～14mm17个，15～24mm7个，≥25mm5个。术前破裂出血30例，其中14例形成脑内血肿；6例因其它疾病或体检时偶然发现。所有病例经DSA检查，部分病人同时行MRA或CTA检查，其中2例病人DSA检查未发现动脉瘤，而CTA则清楚显示动脉瘤。4例病人合并有其它部位动脉瘤，2例为双侧镜影动脉瘤。动脉瘤位于大脑中动脉分叉部30个，分叉部近端7个、远端1个。采用翼点入路，显微镜下打开侧裂，依动脉瘤部位，逆行或顺行沿大脑中动脉主干（支）寻找分离动脉瘤，并夹闭之。结果全部38个动脉瘤均用一个或多个动脉瘤夹夹闭，其中8个大或巨大动脉瘤同时摘除血栓并切除大部瘤体以解除其占位效应。术后恢复良好28例，发生偏瘫失语7例（因局部脑梗塞所致），死亡1例。结论显微手术治疗大脑中动脉动脉瘤可以获得满意疗效，术中应尽量避免损伤大脑中动脉的分支，防止术后发生脑梗塞造成患者神经功能障碍。     

大脑中动脉动脉瘤手术或栓塞治疗的个体化选择

目的探讨个体化选择和互补性应用手术夹闭和血管内栓塞治疗大脑中动脉动脉瘤（MCAA）的临床效果。方法MCCA患者36例,其中22例采用外科手术夹闭,14例采用血管内栓塞治疗。结果出院时改良Rankin量表（mRS）评分0~2分33例,3~5分3例。随访6~12月,mRS评分0~2分34例（94.4%）,3~5分2例（5.6%）。结论个体化选择和互补性的应用手术夹闭和血管内栓塞治疗MCAA是安全、有效的,可减少并发症发生率,降低致残率和死亡率,取得更佳的预后。     

手术切除大脑中动脉巨大夹层动脉瘤一例报告及文献复习

目的探讨大脑中动脉夹层动脉瘤的临床特点和治疗方法。方法结合文献复习，回顾性分析1例表现为巨大占位性病变合并同侧大脑前动脉A1段闭塞的大脑中动脉夹层动脉瘤的手术切除的病例资料。结果经MRI、MRA、CT、DSA等检查及细致的术前评估，对夹层动脉瘤进行孤立切除，术后患患恢复良好，视力视野损害明显改善，未出现新的神经功能障碍。结论多数大脑中动脉夹层动脉瘤可行动脉瘤孤立切除（必要时需血管重建）等手术治疗，以避免出血、梗塞或占位效应导致的神经功能障碍。     

大脑中动脉镜像动脉瘤

目的 探讨大脑中动脉(MCA)镜像动脉瘤的临床特征、影像学改变及显微外科手术治疗的疗效.方法 回顾分析显微外科手术治疗的9例18个MCA镜像动脉瘤患者的临床资料.采取早期与择期、一期与分期相结合的方法处理MCA镜像动脉瘤,原则是先处理破裂动脉瘤,再处理未破裂动脉瘤.结果 动脉瘤直接夹闭17个,未处理1个.依据GOS判断:优良6例,轻残2例,重残1例.结论 将MCA镜像动脉瘤分为Ⅰ型(完全对称型)和Ⅱ型(不完全对称型)有助于判断出血的责任动脉瘤.显微外科手术治疗MCA镜像动脉瘤效果显著.

Abstract：

Objective To study the clinical characteristics, neuroradiological manifestations of mirror - image aneurysm of middle cerebral artery (MCA) and effects of microsurgical management.Method The clinical data of 9 cases with 18 mirror - image aneurysms of MCA which underwent microsurgical operation were analysed retrospectively. The mirror - image aneurysms of MCA were treated through the method of combining early - stage with select - stage operation and one - stage with two - stage operation. The operating principle was the ruptured aneurysm performed treated first and the unruptureed aneurysm performed treated second. Results Seventeen aneurysms were clipped directly and one aneurysm did not treat. Surgical outcome were good in 6 cases, light disability in 2 cases and severe disability in 1 case. Conclusions It can help to determine the responsibility aneurysm of ruptured aneurysms if the mirror - image aneurysm of MCA had been divided into Ⅰ model ( perfectly symmetry model ) and Ⅱ model ( in perfectly symmetry model). The surgical outcome were predominance if the mirror -image aneurysm of MCA performed microsurgical operation.     

大脑中动脉动脉瘤的血管内治疗

目的探讨血管内治疗大脑中动脉动脉瘤的可行性、安全性和有效性。方法回顾性分析采用血管内治疗的24例大脑中动脉动脉瘤患者的临床资料,包括患者年龄、临床分级、动脉瘤出血量、部位、形态、瘤颈宽度、血管痉挛程度及术中应用技术等。结果100%栓塞17例,95%栓塞4例,90%栓塞3例。1例患者术中血管痉挛加重致不完全失语。随访无动脉瘤再破裂出血病例,1例患者出现迟发性血管痉挛。结论血管内治疗大脑中动脉动脉瘤是一种安全、有效的方法。     

大脑中动脉远端动脉瘤破裂1例报告并文献复习

目的探讨大脑中动脉远端动脉瘤破裂的手术治疗。方法手术治疗1例破裂的大脑中动脉M3段动脉瘤并复习有关文献。结果术前CTA提示右侧大脑中动脉M3段动脉瘤,术中成功夹闭动脉瘤并清除血肿减压,术后患者恢复良好。结论大脑中动脉远端动脉瘤少见,破裂后易形成脑内血肿,早期行开颅手术夹闭并清除血肿,预后较好。     

手术切除大脑中动脉巨大球形动脉瘤1例报告

1病例资料患者男性63岁。因“反复头昏7年,伴头痛1周”入住内科,查体无神经系统阳性体征,诊断考虑高血压病。为排除脑梗塞行头颅,CT检查,示左颞占位性病变,考虑脑膜瘤可能性大。经会诊后转入我科。MRI示左颞叶约5.3cm×4.7cm大小类圆形肿块,边界光滑锐利,并见肿块影有搏动性伪影,增强扫描肿块明显强化,考虑左颞叶巨大动脉瘤行DSA全脑血管造影术,提示左颞叶左侧大脑中动脉巨大动脉瘤图,(1)。手术在充分准备后进行全麻后行腰椎穿刺,留置导管于蛛网膜下腔,开颅时缓慢释放脑脊液降低颅内压。手术经扩大翼点,入路开颅。在显微镜下分离侧裂,其…     

Superficial temporal artery–middle cerebral artery bypass surgery in a pediatric giant intracranial aneurysm presenting as migraine-like episodes

Introduction  Aneurysms of the intracranial arteries in the pediatric population are reportedly rare. There is a male predominance, association with connective tissue disorders, as well as bacterial, mycotic infections, and trauma. Results and discussion  Common sites of presentation are the internal carotid artery bifurcation, posterior circulation, and distal segment of middle cerebral artery. Clinical manifestations can vary from seizures and subarachnoidal hemorrhage to headache, irritability, lethargy, vomiting, or focal motor deficits. Current treatment modalities encompass endovascular or surgical approach. Conclusion  We present a case report on an 11-year-old girl with migraine-like episodes due to an underlying giant fusiform middle cerebral artery aneurysm treated successfully with two superficial temporal artery–middle cerebral artery bypasses.     

大脑中动脉瘤21例显微手术治疗

目的探讨大脑中动脉瘤显微手术治疗的临床疗效。方法回顾性分析21例显微手术治疗的大脑中动脉瘤的临床资料。结果所有病例均施行显微外科手术,其中行动脉瘤夹闭17例,动脉瘤切除3例,夹闭加包裹1例。术后严重血管痉挛3例,死亡1例,术后随访20例,随访时间6~30个月,优良19例,中残1例。结论充分的术前评估和合适的手术入路选择是显微外科手术成功治疗大脑中动脉瘤的基础和保证。     

大脑中动脉动脉瘤夹闭术后脑梗死的预防与治疗

目的：探讨大脑中动脉动脉瘤夹闭术后脑梗死的发生原因、机制及其预防措施。方法回顾性分析27例经CT或MRI证实的大脑中动脉动脉瘤夹闭术后脑梗死患者的手术记录及术后的治疗,总结脑梗死的发生时间、发生年龄和发生部位。27例均经翼点入路,开放外侧裂池,充分显露载瘤动脉,解剖出动脉瘤颈部后进行夹闭。结果27例大脑中动脉动脉瘤夹闭术后脑梗死患者发生的年龄偏高,15例出现在术后24 h内,17例位于基底节。随访0．5～2年,恢复良好16例,中残8例,植物生存1例,死亡2例。结论大脑中动脉动脉瘤夹闭术后脑梗死与术中机械性牵拉,血管临时阻断时间过长,阻断部位不当,动脉瘤夹的位置不当及术后血管痉挛引发的迟发性脑缺血有关。熟悉大脑中动脉的解剖,术中准确确定动脉瘤的位置,良好的显微手术技巧,术后采取积极预防措施可以明显降低脑梗死的发生率。     

球囊辅助弹簧圈栓塞治疗大脑中动脉动脉瘤

目的探讨应用球囊辅助弹簧圈栓塞治疗大脑中动脉动脉瘤的可行性、安全性、有效性及操作技巧。方法采用球囊辅助弹簧栓塞治疗25例大脑中动脉动脉瘤,其中动脉瘤位于大脑中动脉M1段末端5例,M2段4例,均应用HyperGlide球囊辅助栓塞;动脉瘤位于大脑中动脉分叉部16例,其中5例应用HyperGlide球囊辅助栓塞,11例应用HyperForm球囊辅助栓塞。结果 1例近全栓塞,其余患者均获100%栓塞,术中出现1例球囊回抽困难,术后3例患者出现脑缺血症状,2例经治疗完全缓解,1例残存不完全性失语。所有患者均随访无再出血。结论球囊辅助弹簧圈栓塞技术是治疗大脑中动脉动脉瘤的一种安全有效的方法,可增加动脉瘤的致密栓塞率,并有效减少并发症的发生。     

Large middle cerebral artery dissecting aneurysm mimicking hemorrhagic stroke

Dissection of intracranial arteries is a rare cause of cerebrovascular diseases commonly presenting as an ischemic stroke. We report a patient with middle cerebral artery dissection who developed a large middle cerebral artery dissecting aneurysm mimicking a hemorrhagic stroke.     

Provocative tests and parent artery occlusion in the endovascular treatment of distal middle cerebral artery pseudoaneurysms

We retrospectively analyzed the angiographic results and endovascular outcomes of 13 patients with pseudoaneurysms (PA) of the distal middle cerebral artery (dMCA). Endovascular provocative tests such as the temporary balloon occlusion test (BOT), and the super-selective intra-arterial "amytal" (amobarbital) test (IAT) were performed in these patients. Four patients underwent the BOT test and all patients underwent the IAT. The provocative tests were negative in 11 patients, after which successful parent artery occlusion (PAO) with detachable coils and onyx-18 was feasibly achieved. Immediate and 6-36 months of follow-up clinical evaluations showed a favorable outcome. Provocative tests are important in not only the selection of endovascular therapeutic methods for PA of the dMCA, but also to assist in accurately assessing patient prognosis.     

应用3D-CTA和颅骨三维重建术精确夹闭大脑中动脉分叉部动脉瘤

目的探讨应用3D-CTA和颅骨三维重建技术精确定位外侧裂开放位置及入路角度,夹闭大脑中动脉分叉部动脉瘤。方法回顾性分析23例大脑中动脉分叉部动脉瘤患者的临床资料,其中男10例,女13例,平均年龄52岁。术前均行3D-CTA和颅骨三维重建,将蝶骨嵴向颅中窝转折处作为骨性标记,参照该骨性标记确定动脉瘤位置,确定开放外侧裂位置及入路方向,进行分离外侧裂夹闭动脉瘤。结果 23例大脑中动脉瘤患者,在开放外侧裂长度1.5~2.0 cm,以45度方向,分离外侧裂深度大约1.5 cm处顺利暴露动脉瘤、M1分叉部及M1末端,均被顺利夹闭,术后有复查头颅CTA,动脉瘤均消失,载瘤动脉通畅,术后1个月随访,患者GOS评分均在4分以上。结论应用3D-CTA和颅骨三维重建技术,精确定位外侧裂开放位置及入路的角度,可以小范围开放外侧裂夹闭大脑中动脉分叉部动脉瘤,获得良好效果。     

A possible case of unruptured middle cerebral artery aneurysm presenting as epileptic seizures

Abstract. We report the case of a 73-year-old man with an unruptured anueurysm of the left middle cerebral artery. The initial sign was complex partial seizures. A standard scalp electroencephalogram was normal while neuropsychological tests revealed a slight deficit of episodic memory. Brain MRI showed an aneurysm at the left middle cerebral artery bifurcation. Cerebral angiography confirmed the presence of a saccular aneurysm at the left middle cerebral artery bifurcation, with a maximum diameter of 12 mm. This case had two main characteristic features: seizures had a quite late onset and were the only symptom the patient experienced.     

血管内再通术治疗症状性慢性大脑中动脉闭塞的初步临床观察

目的初步观察血管内再通术治疗症状性慢性大脑中动脉闭塞的临床疗效。方法纳入24例2019年1—12月郑州大学人民医院脑血管介入治疗中心采用血管内再通术治疗的症状性慢性大脑中动脉闭塞患者,回顾性观察血管再通的成功率、围手术期并发症的发生率及短期随访结果。结果24例患者中,20例(83.3%)血管成功再通,其中脑梗死溶栓治疗分级(TICI)2b级者6例,3级者14例;4例(16.7%)血管再通失败。共6例(25.0%)发生手术相关并发症。其中20例血管再通成功的患者中,发生蛛网膜下腔出血2例,高灌注脑出血1例,3例患者均行保守治疗,术后2周内出血均吸收,未遗留神经功能缺损症状;1例患者血管再通成功后突发心脏骤停死亡。4例血管再通失败的患者中,血管破裂1例,血管夹层1例。23例患者的术后随访时间为(5.0±1.3)个月(3~6个月)。20例血管再通成功的患者中,2例蛛网膜下腔出血者再通血管再次闭塞,末次随访时临床症状再发;其余患者无缺血症状再发,但影像学证实与术后即刻比较,1例血管狭窄率为42%,4例血管狭窄率≤10%。4例血管再通失败的患者脑缺血症状均再发。结论在严格掌握适应证的情况下,采用血管内再通术治疗症状性慢性大脑中动脉闭塞是可行的,相对安全;在短期内可改善患者的临床症状,但有再闭塞的风险;远期疗效需进一步观察。