大鼠实验性囊状动脉瘤生长塑形模型的建立

目的建立大鼠实验性囊状动脉瘤生长塑形模型。方法通过显微手术方法,破坏大鼠颈动脉分叉部位的内膜和内弹力层诱导囊性动脉瘤,在结扎及未结扎对侧颈总动脉的情况下,观察4-5个月,在长、宽、高三个径线上测量动脉瘤的大小,并行正常动脉和动脉瘤壁的组织学观察。结果通过显微手术方法直接破坏大鼠颈动脉分叉部位的内膜和内弹力层,成功诱导出囊状动脉瘤。经过4-5个月的血流冲击,动脉瘤的长、宽、高均明显增大(P<0.01),并且结扎对侧颈总动脉增加同侧血流冲击,可使动脉瘤在高度上继续增大(P<0.01)。正常动脉壁由内膜、中膜和外膜构成,各层结构保持完整。动脉瘤壁上没有内膜,结构排列紊乱,瘤壁变薄,有炎性细胞浸润。结论囊状动脉瘤在长期血流应力的作用下,逐渐增大生长塑形,提供了一个目前所知的较好的研究囊状动脉瘤生长塑形过程中血管生物学机制的动物模型。     

A novel haemodynamic cerebral aneurysm model of rats with normal blood pressure

Cerebral aneurysms of traditional animal models are usually too small to be imaged in vivo. A novel rat model induced by ligation of the unilateral common carotid artery and contralateral pterygopalatine and external carotid arteries was investigatid. To evaluate the morphological changes of the cerebral arteries, synchrotron radiation angiography was utilised at 1 month, 2 months and 3 months after induction. Cerebral aneurysms and expansion of anterior cerebral arteries in these rats were identified when the animals were alive. This novel model is useful for cerebral aneurysm research.     

单侧颈动脉结扎治疗海绵窦段动脉瘤(附15例报告)

目的回顾性分析15例单侧颈动脉结扎治疗海绵窦段动脉瘤患者病历资料,探讨颈动脉结扎的适应证、术前准备、手术方案选择、术后并发症的防治。方法 15例患者均为DSA证实的海绵窦段动脉瘤患者,其中 11例为海绵窦段巨大动脉瘤,4例为创伤性动脉瘤,术前行马它氏试验2周以上,9例为缓慢夹闭颈内动脉再行颈内动脉结扎术,2例行直接结扎颈内动脉,4例行直接结扎颈总动脉。8例术中术后行Doppler监测,全部病例术后行心电、血压等监护。结果 15例患者中,术后2例出现并发症,1例为术后第5周缓慢出现对侧肢体偏瘫,1例为术后 4h出现意识变差,肢体活动障碍,而行急诊手术再次开放颈内动脉,但术后患者仍有偏瘫。结论缓慢夹闭颈内动脉是治疗海绵窦段动脉瘤的一种可行方法。     

Kissing aneurysms of the distal anterior cerebral artery

Kissing aneurysms, a particular type of multiple aneurysm are rare. A kissing aneurysms was identified at the distal anterior cerebral artery (ACA) in a 59-year-old male patient diagnosed with subarachnoid hemorrhage (SAH). The use of three-dimensional intracranial CT angiograms revealed that kissing aneurysms (that is, an aneurysm with a bilateral symmetrical mirror image) were located at the distal ACA and diffuse SAH in basal, sylvian, and interhemispheric cisterns. Both conventional carotid angiograms showed that both distal ACA aneurysms were seen separately on both internal carotid angiograms. Two aneurysms were observed simultaneously on carotid compression of either side. Some particular cautions required in diagnosing and treating kissing aneurysms are discussed, together with a literature review.     

Involvement of internal elastic lamina in development of induced cerebral aneurysms in rats

To elucidate the role of the internal elastic lamina in the development of cerebral aneurysm, the bifurcation of the anterior cerebral artery and olfactory artery was histologically studied in control and experimental rats treated with unilateral carotid ligation and renal hypertension. Various stages of aneurysm formation were compared, and it was found that early aneurysmal changes were always present just distal to the apical intimal pad on the anterior cerebral artery side. The internal elastic lamina was thinned and fragmented just distal to the pad even in the very early stage of aneurysm formation when the medial layer was still present. In control rats, the internal elastic lamina had a tendency to thin and fragment at the site where aneurysms would develop in experimental rats. Our study shows that changes of the internal elastic lamina were present just distal to the pad even in control rats, which never develop cerebral aneurysms. Under hemodynamic stress augmented by experimental treatments, further degenerative changes of the internal elastic lamina and involvement of the medial layer are considered to occur and result in aneurysm formation there.     

醋酸纤维素聚合物栓塞实验性宽颈动脉瘤的组织学研究

目的观察实验性宽颈动脉瘤被非黏附性液体栓塞剂醋酸纤维素聚合物(CAP)栓塞后的组织学变化。方法犬3只,将颈外动脉和股深动脉结扎建立动脉残端性宽颈动脉瘤模型,随即向动脉瘤腔内注射CAP(注射时用血管夹夹闭动脉瘤颈)。3周后取动脉瘤标本做电镜检查。结果3只动物共制作12个动脉瘤,7个用CAP栓塞。扫描电镜显示瘤体内的CAP团块与动脉瘤内膜紧密贴合,有4个动脉瘤的瘤颈被较完整的新生内皮细胞覆盖。透射电镜显示瘤壁存在轻度炎症,瘤腔被CAP及纤维组织充填。结论宽颈动脉瘤被CAP栓塞后能够达到组织学上表现为瘤颈内皮化和瘤腔纤维化的解剖愈合。     

Cerebral aneurysms causing visual symptoms: their features and surgical outcome

Cerebral aneurysms causing visual symptoms before surgery are relatively rare. We have experience with 17 cases of such aneurysms and report their clinical features and surgical outcome. The locations of aneurysms presenting with visual dysfunction in our series are as follows: internal carotid (IC)-cavernous aneurysms in six of 29 total cases, 21%; IC-ophthalmic aneurysms in nine of 36 total cases, 25%; and anterior communicating artery (A com A) aneurysms in two of 217 total cases, 1%. The size of the aneurysms, the period between the onset of symptoms and surgical treatment, the pre- and post-operative visual function, and the surgical methods used to treat the aneurysm were analyzed. All the visually symptomatic cases featured large (15–24 mm) or giant (>25 mm) aneurysms. Visual symptoms occurred before aneurysmal rupture in all cases but one. The type of visual field defect and the degree of reduced visual acuity were highly variable, without a typical clinical presentation. Five out of six IC-cavernous aneurysms were treated surgically with common carotid artery (CC) ligation or IC ligation with superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis. Three of these cases showed improvement of visual symptoms after surgery. Six out of nine IC-ophthalmic aneurysms were treated surgically (CC ligation or direct clipping), with four cases showing improvement of visual symptoms after surgery. One case of an A com A aneurysm featured a ruptured aneurysm that had physically penetrated the optic chiasm, while the other case was a giant unruptured aneurysm. The interval between the onset of symptoms and surgical treatment was the only factor identified which affected the clinical outcome of the aneurysms presenting with visual dysfunction. All cases that were determined to show improvement of visual function were treated surgically within 3 months of the onset of symptoms. Cerebral aneurysms presenting with visual dysfunction before surgery are most commonly large or giant, and unruptured. Recovery of visual function can most often be expected when surgical treatment is performed expeditiously, before the visual dysfunction becomes irreversible.     

选择性血管结扎法建立大鼠脑动脉瘤模型

目的 探讨选择性血管结扎法对大鼠脑动脉瘤形成的影响.方法 SD大鼠50只,随机分为3组:(1)A组20只:结扎左侧颈总动脉+两侧肾动脉后支(各侧1支);(2)B组20只:"8"字形结扎左侧颈内、外动脉+电凝并切断两侧肾动脉(各侧只留1个分支);(3)C组为假手术组10只.术后喂养含0.9%的盐及0.12%β-氨基丙腈的饲料.4周后处死,取大鼠脑动脉Willis环,在光镜下观察其病理的变化.结果 A组大鼠ACA/OA分叉处均未见有进展期动脉瘤,仅3个早期动脉瘤样改变.B组大鼠中发现12个进展期动脉瘤和2个早期动脉瘤样改变.C组中未见动脉瘤形成.结论 血管壁结构的破坏或变弱和高血液动力学压力是动脉瘤形成的主要因素.     

Bilateral hypoplastic internal carotid arteries with multiple cerebral aneurysms

A 60-year-old man with massive subarachnoid hemorrhage is reported. Radiologically, bilateral occlusion of the internal carotid arteries and multiple cerebral aneurysms of the saccular type were detected. Postmortem examination revealed that the internal carotid arteries were markedly diminutive and completely occluded by mesenchymal fibrous tissue. The pathogenesis of the diminutive internal carotid arteries and the cerebral aneurysms were briefly discussed.     

血管内支架结合电解可脱弹簧圈治疗颅内宽颈动脉瘤

目的 总结101管内芰架结合电解可脱弹簧圈治疗颅内宽颈动脉瘤的经验。方法 6例颈内动脉宽颈动脉瘤植入Neuroform支架掇盖动脉瘤颈，再将微导管通过支架网眼超选入动脉瘤腔填塞电解可脱弹簧圈，结果 5例动脉瘤达到致密填塞，1例大部填塞，载瘤动脉通畅，患者均恢复良好。结论 血管内支架结合微弹簧陶是治疗颅内宽颈动脉瘤的有效方法。     

脑供血动脉闭塞与颅内动脉瘤形成关系的初步分析

目的初步评价脑供血动脉闭塞与颅内动脉瘤发生之间的关系。方法本研究分析了8例脑供血动脉闭塞伴有颅内动脉瘤患者的临床资料。结果8例患者中单侧颈内动脉闭塞7例,双侧颈内动脉及一侧椎动脉同时闭塞1例。8例患者共检出动脉瘤11枚,多发动脉瘤患者3例,所有动脉瘤均位于Willis环,其中9枚动脉瘤采用了血管内栓塞治疗,致密栓塞5例,本组病例未发生技术相关并发症。I临床随访9个月～14年,提示所有患者出院后病情稳定,无新发神经功能缺损。结论脑供血动脉闭塞后代偿血管的血流动力学变化与颅内动脉瘤的生成密切相关。     

Multiple basilar trunk aneurysms and bilateral internal carotid artery hypoplasia

We describe a case of a 32-year-old woman with bilateral hypoplastic internal carotid arteries who presented with subarachnoid haemorrhage and was found to have two basilar trunk aneurysms. Carotid angiography showed that both internal carotid arteries were narrowed at their origin and terminated at the cervical segment. Vertebral angiography demonstrated a dilated vertebrobasilar system which supplied sufficient blood flow for both cerebral hemispheres through the posterior communicating arteries. The patient was successfully treated by multiple operations.     

脑动脉硬化斑块与脑动脉瘤的CTA特征分析

目的 探讨脑动脉硬化（AS）斑块与脑动脉瘤（CA）的CT血管造影（CTA）特征。方法 回顾性分析2015年12月至2018年12月初步诊断AS、CA的735例病人的影像学资料,所有病人均经DSA确诊。结果 735例中,单纯AS斑块216例,共检出747个斑块;单纯CA共50例,检出53个动脉瘤;CA合并AS斑块143例,检出512个斑块,218个动脉瘤;无CA、AS斑块326例。AS斑块病人CA发生率（39.8%,143/359）明显高于无AS斑块病人（13.3%,50/376;P<0.05）;而且,AS斑块病人囊状动脉瘤发生率（48.5%,50/103）较无AS斑块病人明显增高（39.6%,143/361;P<0.05）。512个斑块中,软斑块113个,硬斑块205个,混合斑块194个;颈内动脉分叉处近端（包括颈内动脉后交通段、眼动脉段、海绵窦段）共284个,而其中硬斑块比例（77.1%,158/205）和混合斑块比例（50.5%,98/194）均明显高于软斑块比例（24.8%,28/113;P<0.05）。颈内动脉分叉处近端斑块平均数量[（4.30 ±0.90）个/例]明显高于其他部位斑块平均数量[（2.51±1.02）个/例;P<0.05]。结论 AS斑块和囊状CA在颅内动脉发生的空间位置特征相同,AS斑块促进囊性CA形成,两者的形成与血流动力学、脑血管结构相关。     

Giant aneurysms: surgical treatment

We have reviewed our experience with the surgical management of giant aneurysms of the cerebral circulation. Patients with aneurysms at the base of the skull, below the subarachnoid space, were treated by proximal ligation and arterial bypass with trapping intracranially if necessary. Patients harboring giant aneurysms located on arteries within the subarachnoid space were treated by direct attack on the aneurysm aided by hypothermia and elective circulatory arrest. Elective circulatory arrest allows the surgeon more control in dissecting out and obliterating giant aneurysms. We were able to exclude these lesions from the circulation without sacrificing the parent artery. There was no mortality and morbidity seems acceptably low.     

大脑中动脉分叉部动脉瘤分型与分支管径关系的研究

目的探讨大脑中动脉（MCA）分叉部动脉瘤的分型与两分支管径的关系。方法以14例偏侧型动脉瘤和8例经典型动脉瘤为研究对象,通过3D—DsA测量患侧MCA两支干起始处的管径并计算其支干管径比,对两组动脉瘤的支干管径比进行两独立样本t检验。结果偏侧型和经典型两组动脉瘤的支干管径比具有统计学差异（P〈0．05）。结论对于双干型MCA,两分支管径相差较小的多发生经典型动脉瘤,相差较大的多发生偏侧型动脉瘤。     

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囊,2个巨型动脉瘤行M_1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.     

脑动脉瘤模型制作及高血压对其影响的实验研究

目的 建立脑动脉瘤动物模型并初步探讨高血压对脑动脉瘤的影响.方法 45只雄性SD大鼠按随机数字表法分为高血压组、正常血压组和正常对照组.高血压组行脑动脉瘤模型制作+双侧肾动脉狭窄术:正常血压组只建立脑动脉瘤模型:正常对照组不予任何处理.各组在术前,术后6周、12周三个时间点分别测量各组大鼠动脉收缩压.术后12周测量脑动脉瘤大小,并灌注固定,取脑动脉瘤部位血管组织,应用HE染色、Van Geson染色和Verhoeff染色进行病理检查.结果 高血压组在处死前血压明显升高[(197.48±15.44)mm Hg],与手术前的血压[(104.40±14.70)mm Hg]相比差异有统计学意义(P<0.05);处死前脑动脉瘤的长度[(2.38±0.31)mm]和宽度[(1.89±0.35)mm]与脑动脉瘤制作完成时的长度[(1.62±0.18)mm]和宽度[(1.36±0.09)mm]相比差异有统计学意义(P<0.05);正常血压组和正常对照组无明显变化.病理检查显示高血压组血管内膜消失,弹力层完全断裂;正常血压组尚存部分弹性纤维;正常对照组血管组织无改变.结论本实验采用的脑动脉瘤模型稳定性好,制作方便,具有与人类脑动脉瘤相似的形态和病理结构.高血压对脑动脉瘤的弹力蛋白和胶原蛋白有明显影响,是影响脑动脉瘤增大的重要因素之一.     

大脑后动脉远端动脉瘤的血管内介入治疗

目的 探讨大脑后动脉远端动脉瘤的血管内介入治疗方法及特点.方法 10例动脉瘤,P2段6例(囊状2例、梭形2例、夹层2例)、P2-P3交界处1例(夹层)、P3段3例(夹层).对于囊状动脉瘤采用弹簧圈栓塞并保留载瘤动脉的方法;梭形动脉瘤采用支架重建瘤腔的方法;P2段及P2-P3交界夹层动脉瘤采用弹簧圈栓塞并闭塞载瘤动脉的方法;P3段夹层动脉瘤采用Glubran胶栓塞并闭塞载瘤动脉的方法.结果 随访半年至1年,预后良好.DSA复查9例,未见动脉瘤复发.结论 对于大脑后动脉远端动脉瘤,根据动脉瘤的类型及部位采用不同的血管内介入治疗方法,短期随访可以获得较好的疗效.     

Evidence for apoptosis in human intracranial aneurysms

Abstract

There is no accepted hypothesis explaining the mechanism of growth and the subsequent rupture of intracranial aneurysms. Both congenital and acquired factors are believed to contribute to the formation. and development of intracranial aneurysms. Apoptosis, commonly observed under a wide range of physiological conditions, occurs in the various pathological situations including some vascular diseases. We discuss the contribution of apoptosis to the formation and the rupture ofhuman intracranial aneurysm. Five aneurysms without surgical treatment from four autopsy cases suffering from subarachnoid hemorrhage were studied by a specific in situ nick-end labeling method for DNA breaks. Conventional hematoxylin and eosin staining, and van Gieson staining for elastic fiber were also performed. Nonatherosclerotic regions in the parent arteries of the aneurysms or contralateral arteries were examined for controls in the same manner. Many apoptotic cells with nuclear DNA fragmentation were recognized in neck and dome of aneurysms, while few findings for DNA breaks were available in control arteries. Evidence for apoptosis was present in the spindle-shaped cells constituting the thin wall close to the rupture point within aneurysmal dome. These results strongly suggest that apoptosis plays an important role not only in the development of intracranial aneurysms but also in the aneurysmal rupture. [Neural Res 1998; 20: 127–130]     

椎基底动脉瘤的手术治疗

目的 探讨手术治疗椎基底动脉瘤的方法.方法 26例28个椎基底动脉瘤患者.动脉瘤破裂出血9例;16例基底动脉瘤,10例椎动脉瘤.5例基底动脉顶部动脉瘤经翼点入路,5例基底动脉顶部和2例基底动脉上段动脉瘤用额颞颧(切断颧弓、扩大中颅窝底)入路,4例基底动脉中段动脉瘤采用乙状窦前(岩骨)和远外侧联合入路.10例椎动脉瘤中,4例椎动脉瘤采用乙状窦前(岩骨)和岩骨联合入路,6例取用远外侧-枕骨髁联合入路.11例术中临时阻断血管时间延长或可能影响开通血管患者行血管搭桥术,其中颈内动脉大脑后动脉P2段移植搭桥2例,颈外动脉与大脑后动脉P2段移植搭桥4例,椎动脉移植搭桥2例,枕动脉与小脑后下动脉搭桥3例.结果 术后恢复正常工作,无神经功能障碍者:基底动脉顶端动脉瘤9例,基底动脉干动脉瘤5例,椎动脉瘤10例,良好率为92%.1例基底动脉顶端动脉瘤患者术后有严重神经功能缺失,生活不能自理;1例基底动脉主干动脉瘤术后穿通动脉闭塞引起中脑缺血,术后20 d死亡.结论 选择适合的颅底手术入路有利于术中获得充分的手术操作空间.对于单纯手术夹闭困难的动脉瘤,用血管移植搭桥的方法,可以避免因夹闭动脉瘤和临时阻断载瘤动脉出现术后脑缺血.