颅内血管搭桥辅助治疗大脑中动脉远端梭形动脉瘤

目的探讨颅内大脑中动脉远端梭形动脉瘤的手术方法及疗效。方法回顾性分析4例大脑中动脉远端梭形动脉瘤病人的临床资料,其中多发1例,单发3例。巨大血栓性动脉瘤2例,动脉硬化性动脉瘤2例。均采用扩大翼点入路,取颞浅动脉作为移植血管,行动脉瘤远近端动脉和移植血管的端侧或端端吻合。吻合成功后行动脉瘤孤立或切除术。术中体感诱发电位监测以便及时发现术中脑缺血。结果动脉瘤切除2例,孤立2例。影像学复查显示无脑梗死,搭桥血管通畅。术后发生一过性口角抽搐1例,治疗后消失;双侧动眼神经麻痹1例,与手术牵拉有关。随访8～14个月,均恢复,无神经功能障碍。结论颅内动脉搭桥手术难度较大,术前精确评估动脉瘤及其周围血管的情况,制定合理的手术计划,可有效的治疗巨大难治性动脉瘤。     

以脑缺血为首发症状的前循环动脉瘤临床特点与治疗

目的 探讨以脑缺血为首发症状的前循环动脉瘤临床特点及治疗策略。方法 回顾性分析2016年9月至2021年12月收治的10例以脑缺血为首发症状前循环动脉瘤患者的临床资料。结果 10例患者中，以短暂性脑缺血发作（transient ischemic attack,TIA）为首发症状者4例，以缺血性卒中为首发症状者6例；颈内动脉动脉瘤3例，大脑中动脉瘤7例；巨大动脉瘤5例，大动脉瘤4例，小动脉瘤1例；单纯囊状动脉瘤3例，囊状动脉瘤合并血栓形成3例，夹层动脉瘤4例；治疗方式上，支架辅助弹簧圈栓塞1例，显微手术夹闭1例，动脉瘤切除3例，其中1例动脉瘤切除后原位吻合，2例辅以颞浅动脉-大脑中动脉（STA-MCA）搭桥术，动脉瘤孤立联合STA-MCA搭桥术3例，近端阻断联合颈外动脉-桡动脉-大脑中动脉（ECA-RA-MCA）高流量搭桥1例，颈内动脉缩窄联合STA-MCA搭桥1例。术后除1例患者出现同侧基底节小范围梗死致对侧肌力下降外，其他患者未出现新的神经功能障碍。术后复查8例动脉瘤消失，2例动脉瘤缩小。术后随访9～72个月，平均35.3个月，随访期间无蛛网膜下腔出血或新发脑梗死，无动脉瘤复发、扩大...     

颅内后循环动脉瘤的显微手术治疗

目的探讨颅内后循环动脉瘤显微手术治疗的要点。方法后循环动脉瘤患者26例（2例伴血管畸形），其中基底动脉顶端动脉瘤7例，小脑下后动脉瘤及大脑后动脉瘤各6例，椎动脉夹层动脉瘤2例，小脑上动脉瘤3例，小脑下前动脉瘤2例。入院时按Hunt-Hess分级，Ⅰ-Ⅲ级23例，Ⅳ-Ⅴ级3例。动脉瘤颈夹闭18例，瘤颈夹闭及瘤囊切除5例，血管成型术2例，动脉瘤孤立1例。结果出院时按GOS评分，19例恢复良好，4例轻度神经功能障碍（轻度偏瘫2例，共济失调及吞咽困难各1例），2例重残，1例死亡。结论颅内后循环动脉瘤手术难度大，选择正确的入路，充分暴露动脉瘤是手术成功的关键。     

3 D Slicer 软件辅助大脑中动脉 M4 段动脉瘤手术 1 例及文献复习

目的探讨远端大脑中动脉瘤的临床特征、治疗和手术方案。方法回顾性分析1例大脑中动脉远端动脉瘤患者的临床资料和手术方案。并结合复习该型动脉瘤的相关文献分析其发病特点、临床表现和治疗策略。结果患者为男性62岁,经CTA诊断为右侧远端中动脉M4段动脉瘤,合并颞叶血肿;术前神经功能障碍程度轻。采用3D Slicer软件对动脉瘤和血肿进行三维建模,辅助定位和手术设计,术中动脉瘤顺利找到并切除。术后患者的神经功能障碍恢复。结论远端大脑中动脉瘤颅内血肿和神经功能障碍的发生率高,血管分支结构复杂且变异率高;病变藏于岛盖内或皮层下脑组织中,定位和手术非常困难。3D Slicer软件重建较传统影像学检查和导航技术具有更高的可视化和便利性,对提高该型动脉瘤的手术效果具有重要意义。     

大脑中动脉瘤伴侧裂区血肿的诊治策略

目的 探讨大脑中动脉动脉瘤(MCAAs)伴侧裂区血肿的诊断及手术治疗经验. 方法 同顾性分析解放军总医院神经外科自2006年11月至2011年5月收治的21例MCAAs伴侧裂区血肿患者的临床资料,探讨显微外科手术治疗MCAAs伴侧裂区血肿的经验. 结果 本组患者中12例行单纯动脉瘤夹夹闭,8例行动脉瘤重新塑形并多枚动脉瘤夹夹毕,1例行动脉瘤孤立、颞浅动脉大脑中动脉架桥术;患者出院时GOS评分:4～5分16例;3分3例;2分1例;1分1例,其中神经功能障碍好转者15例,神经功能障碍无变化4例,神经功能障碍加重者1例,死亡1例. 结论 MCAAs伴侧裂区血肿,应防止误诊为高血压脑出血,显微外科手术中行载瘤动脉血流监测及体感诱发电位监测可提高治疗效果.     

大脑中动脉夹层动脉瘤临床特点及治疗的荟萃分析

目的 综合分析有关大脑中动脉夹层动脉瘤临床报道病例的临床表现、治疗特点以及预后情况。方法 用关键词途径对1990年1月～2003年5月MEDLINE数据库进行光盘检索。对34例临床确诊为大脑中动脉夹层动脉瘤的病例报道资料进行综合分析，并进行统计学处理。结果 大脑中动脉夹层动脉瘤无明显性别和临床表现上的差异，其好发于中动脉M1段和M2段。破裂或未破裂的中动脉夹层动脉瘤的手术组预后均明显优于保守组，两者统计学差异明显。结论 大脑中动脉夹层动脉瘤是一种较为罕见的脑血管疾病。对于破裂或未破裂(尤其是M1段)的大脑中动脉夹层动脉瘤应于诊断后早期进行手术干预，改善患者预后。     

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。     

前循环巨大动脉瘤的手术治疗

目的 对1985年以来经手术治疗的18例前循环巨大动脉瘤作一回顾性分析,方法 行动脉瘤瘤颈夹闭术11例,动脉瘤孤立或孤立后切除4例,动脉瘤切除或孤立后载瘤动脉重建2例,动脉瘤包裹1例。结果 动脉瘤瘤颈夹闭术的11例病人中,除1例术前Hunt-Hess分级Ⅳ级的病人术后重残外,均恢复良好。动脉瘤孤立或孤立后切除的4例病人中,1例后交通动脉瘤（PCoA)病人虽术前血管造影证实侧支循环充分,但术后出现暂时性对侧轻偏瘫。另1例大脑中动脉（MCA）动脉瘤病人术后第6天因术野血肿再次进行手术,出院时能独立行走。行动脉瘤切除或孤立后载瘤动脉重建的2例病人恢复良好。动脉瘤包裹术的1例病人术后因再出血死亡。结论 为消除巨大动脉瘤的压迫症状和潜在的出血危险,对前循环巨大动脉瘤主张积极的手术治疗。动脉瘤瘤颈夹闭并保留载瘤动脉通畅是首选治疗,对必需行动脉瘤孤立且交叉循环不良的病例,应尽可能重建载瘤动脉。     

大脑中动脉瘤的显微外科治疗

报告34例大脑中动脉瘤显微外科手术的经验，其中1例有2个动脉瘤，共计35个动脉瘤。本组中大型和巨型动脉瘤14个(40%)，除2个大脑中动脉主干梭形动脉瘤行动脉瘤包裹，2个巨型动脉瘤行M1阻断伴颅内外动脉吻合外，其余（88%)均做动脉瘤颈夹闭或动脉瘤切除无手术死亡，2例术后发生神经功能缺失。平均随访6年，优良率达93．8%。对手术入路、手术方法加以讨论。     

颅内-外血管搭桥加孤立术治疗大脑中动脉复杂动脉瘤

目的探讨颅内-外血管搭桥加动脉瘤孤立术在大脑中动脉复杂动脉瘤治疗中的方法和效果。方法对6例大脑中动脉复杂动脉瘤患者采用颅内-外血管搭桥加动脉瘤孤立手术。术后复查脑血管造影和(或)超声评价搭桥是否通畅,并就相关临床资料进行分析。结果颞浅动脉-大脑中动脉搭桥4例中,吻合口通畅4例,运动性语言障碍加重1例。颈外动脉-大隐静脉移植-大脑中动脉搭桥2例,搭桥血管不通畅1例。随访2-17个月,恢复良好5例,生活自理1例。结论颅内-外血管搭桥加动脉瘤孤立术是治疗大脑中动脉复杂动脉瘤的可行方法。     

A case of dissecting aneurysm of the basilar artery extended from the top of the basilar artery to the proximal part]

A rare case of the dissecting aneurysm of the basilar artery is reported. A 48-year-old man was admitted to our hospital because of a sudden onset comatose state. An hour later he recovered consciousness with the residual disturbance of the vertical ocular movement. Computed tomogram on second day revealed low density lesions in the medial part of the bilateral thalamus, and the mesencephalic tegmentum and the cerebellar peduncle on the left side. Cerebral angiograms on the same day and 13th day showed a double lumen sign of the basilar artery and slight extension of the dissecting aneurysm, respectively. However, the cerebral angiogram 6 months after the onset revealed a little bit shrinkage of the aneurysm. The patient was treated conservatively and is in good condition with slight limitation of the downward gaze 10 months after the onset. We reviewed the clinical sign, cerebral angiogram, treatment and prognosis of the dissecting aneurysm of the basilar artery.     

Dissecting aneurysm of the middle cerebral artery associated with subarachnoid haemorrhage

A 73-year-old male with known hypertension presented with subarachnoid haemorrhage due to a ruptured dissecting aneurysm of the middle cerebral artery. Angiography showed a dilatation with proximal and distal narrowing of the right middle cerebral artery. Conservative treatment resulted in almost complete resolution of the angiographic abnormalities 6 months later. Dissecting aneurysms of the middle cerebral artery with haemorrhagic manifestations are extremely rare and are not generally recognized as a cause of subarachnoid haemorrhage. If angiography fails to demonstrate a saccular aneurysm in a patient with subarachnoid haemorrhage, a ruptured dissecting aneurysm may be a possible cause. Repeat angiography should be performed for definitive diagnosis. More knowledge about the natural course is essential before determining whether surgical treatment is always necessary.     

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.     

Childhood subarachnoid hemorrhage associated with fibromuscular dysplasia

A rare case of childhood subarachnoid hemorrhage (SAH) is reported. A 5-year-old boy presented with SAH. A cerebral angiogram showed obstruction of the first segment of the left anterior cerebral artery (A1). The A1 was surgically trapped to prevent rebleeding. Proliferation of myofibroblasts was revealed in the intima of the A1. Cerebral infarction appeared in the territory of the left middle cerebral artery (MCA) on day 2 after onset of SAH, and the patient suffered a second SAH on day 26. The second angiogram showed stenosis and a saccular aneurysm in the left MCA. A second surgery, neck clipping of the aneurysm, was needed. The multiple arterial lesions and histological findings indicated that the SAHs and the infarction were caused by the dissecting aneurysm affected with fibromuscular dysplasia (FMD). Intracranial FMD is mainly detected in children and causes cerebral ischemia and bleeding. Surgical treatment of childhood SAH should be discretely chosen with due consideration for FMD.     

Carotid Micromesh Stent for the Cervical Carotid Artery Dissecting Aneurysm in a Patient with Vascular Eagle Syndrome

ObjectivesAn elongated styloid process may cause vascular Eagle syndrome that includes cervical carotid artery (CCA) dissection with stenosis and aneurysm formation. There are only four reported cases with vascular Eagle syndrome-related CCA dissecting aneurysm treated with carotid artery stenting (CAS). This is the first report of applying a dual-layer nitinol micromesh stent (CASPER) for vascular Eagle syndrome-related CCA dissecting aneurysm.Case presentationA 38-year-old man presented with a sudden onset of aphasia and right hemiplegia. Cerebral angiography demonstrated the left CCA dissecting aneurysm. The superior trunk of the left middle cerebral artery (MCA) was also occluded, and emergent thrombectomy was performed. Computed tomography with angiography (CTA) revealed that a 33 mm-long styloid process compressed the CCA at the aneurysm formation. Three weeks later, a CASPER stent was applied for the CCA aneurysm under the flow reversal system. Immediately after stent placement, blood flow in the aneurysm became stagnant, and postoperative CTA demonstrated regression of the aneurysm. The aneurysm did not recur for 6 months with no styloid process resection.ConclusionsThe dual-layer nitinol micromesh stent (CASPER) was useful to treat vascular Eagle syndrome-related CCA dissecting aneurysm.     

Dissecting aneurysm of the anterior cerebral artery with Rubinstein-Taybi syndrome--a case report

The Rubinstein-Taybi syndrome (RTS) is defined congenital anomalies and is characterized by postnatal growth deficiency, microcephaly, specific facial characteristics, broad thumbs and big toes, and mental retardation. RTS displays an autosomal dominant inheritance pattern and is typically caused by cAMP response element-binding (CREB)-binding protein deficiency. Various complications such as eye anomalies and a variety of congenital heart defects are reported in such cases. We treated an RTS patient who had a dissecting aneurysm of the anterior cerebral artery. The patient was a 44-year-old man who was brought to our hospital because of sudden left hemiplegia. Magnetic resonance images showed a cerebral infarction caused by anterior cerebral artery dissection. Coil embolization was performed on enlargement of the dissecting aneurysm, and the procedure was successful. Conclusion: RTS may be accompanied by cerebrovascular disease.     

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.     

Obliteration of bilateral dissecting aneurysms of the vertebral arteries following repeated subarachnoid hemorrhage: a case report

A 51-year-old man presented with loss of consciousness when he underwent urological examination at another hospital. CT scans showed subarachnoid hemorrhage, and cerebral angiography showed bilateral dissecting aneurysms of the vertebral arteries. Following ventricular drainage, the lesion was managed conservatively with blood pressure control but again ruptured on day 8. Cerebral angiography revealed narrowing of both the dissecting aneurysms. On day 11, the right vertebral artery had been spontaneously obliterated and the right dissecting aneurysm was filled in a retrograde fashion via the left vertebral artery. Proximal occlusion of the right vertebral artery was performed to prevent recanalization. Two months later, cerebral angiography revealed that both vertebral arteries were obliterated and the basilar artery and right posterior inferior cerebellar artery were filled via the right posterior communicating artery. The present case demonstrated that the hemodynamic status of bilateral dissecting aneurysms of the vertebral artery changed variably indicating the necessity of careful angiographic observation.     

Obliteration of bilateral dissecting aneurysms of the vertebral arteries following repeated subarachnoid hemorrhage: A case report

Abstract

A 51-year-old man presented with loss of consciousness when he underwent urological examination at another hospital. CT scans showed subarachnoid hemorrhage, and cerebral angiography showed bilateral dissecting aneurysms of the vertebral arteries. Following ventricular drainage, the lesion was managed conservatively with blood pressure control but again ruptured on day 8. Cerebral angiography revealed narrowing of both the dissecting aneurysms. On day 11, the right vertebral artery had been spontaneously obliterated and the right dissecting aneurysm was filled in a retrograde fashion via the left vertebral artery. Proximal occlusion of the right vertebral artery was performed to prevent recanalization. Two months later, cerebral angiography revealed that both vertebral arteries were obliterated and the basilar artery and right posterior inferior cerebellar artery were filled via the right posterior communicating artery. The present case demonstrated that the hemodynamic status of bilateral dissecting aneurysms of the vertebral artery changed variably indicating the necessity of careful angiographic observation.     

Dissecting aneurysm of the middle cerebral artery with subarachnoid hemorrhage undetectable on preoperative neuroradiological findings: case report]

We report a rare case of a dissecting aneurysm (DA) of the middle cerebral artery(MCA) associated with subarachnoid hemorrhage(SAH) undetectable on preoperative neuroradiological findings. A 64-year-old man was admitted to our hospital because of a sudden onset of occipital headache. CT scan showed SAH mainly in the basal cisterns and left sylvian fissure. Three-dimensional CT angiograms revealed a saccular aneurysmal protuberance at the left internal carotid-posterior communicating artery (IC-PC) region, whereas no abnormal findings at the M2 inferior trunk of the left MCA. Left internal carotid angiograms showed a saccular aneurysmal protuberance at the ICPC region. So, preoperative diagnosis of a ruptured left IC-PC aneurysm was based on the above neuroradiological findings. The patient was surgically treated through the left pterional transsylvian approach. No aneurysm was observed either at the left IC-PC region or the trifurcation of the left MCA. The posterior communicating artery had severe arteriosclerotic change was observed. Aneurysmal dilatation with a dark-purplish & reddish wall was detected at the M2 inferior trunk of the left MCA, which was thought to be the cause of the current SAH. To prevent bleeding, the lesion was clipped on wrapping with Bemsheets. Left internal carotid angiograms obtained 40 days after the onset revealed no occlusive findings at the M2 inferior trunk of the MCA was clipped on wrapping with Bemsheets. Retrospectively, preoperative angiograms revealed severe stenosis at the M2 inferior trunk of the MCA. The postoperative course was uneventful and the patient was discharged without neurological deficits. There has been no rebleeding nor new ischemic attack during the ten months since surgery. The 20 reported cases of a DA of the MCA associated with SAH with our case are reviewed and their neuroradiological and clinical features are discussed.