血管内介入治疗血管病变压迫所致的后颅凹神经损害

目的探讨利用单纯血管内支架置入或结合螺旋圈栓塞术治疗椎基底动脉瘤或扩张的方法,解除其对周围神经的动脉搏动性压迫,而达到经血管内进行神经减压的有效性及安全性。方法选择椎基底动脉系统的动脉瘤、瘤样扩张或动脉纡曲患者11例,接受经股动脉途径单纯血管内支架置入8例(单支架6例,双支架2例),支架结合螺旋圈栓塞3例。术后继续抗血小板治疗3个月。结果 11例患者(13枚)支架置入均获成功,成功率100%。即刻行数字减影血管造影(digital subtractlon angiography,DSA)复查,3例椎动脉夹层动脉瘤缩小,3例支架结合弹簧圈栓塞动脉瘤基本消失。术后头痛症状全部消失,2例饮水呛咳症状消除。本组无并发症发生。随访4-20个月,均无头痛及饮水呛咳等症状发作。6例行多普勒超声复查,均显示支架内通畅。4例夹层动脉瘤行DSA复查,3例动脉瘤消失,1例动脉瘤明显缩小,支架内血流通畅。结论经血管内支架置入式的血管内神经减压治疗因动脉搏动性挤压后颅凹神经损害是安全有效的方法。

Endovascular interventional treatment for the damage of nerve in posterior fossa caused by compression of vascular lesion

Objective To evaluate the efficacy and safety of the method of endovascular decompression of nerve by pure stenting or stenting combined with coiling to treat fusiform and dissection aneurysm or expansion of vertebro-basilar artery for elimination of arterial beating compression to the surrounding nerve. Methods Eleven cases who were diagnosed as fusiform and dissection aneurysm or expanded or tortuous vertebrobasilar artery underwent simple stenting in 8 cases and stenting combined with coiling in 3 cases by the approach of femoral artery. After the interventional procedure, continuous anti-platelet drug treatment was given for 3 months. Results The technique success rate was 100%. The postoperative digital subtraction angiography (DSA) showed that the dissection aneurysm of vertebral artery reduced in 3 cases and the aneurysm disappeared in 3 cases. The clinical symptom of headache disappeared in all the 11 cases and choking by water was eliminated in 2 cases after operation. No complication occurred. During follow-up for 4 to 20 months no headache or choking by water occurred in all the cases and follow-up DSA of 4 cases showed the dissection aneurysm was eliminated in 3 cases and reduced obviously in 1 case. Follow-up Doppler examination of 6 cases showed that the blood flow in stent was clear. Conclusion Endovascular decompression of nerve by stenting to treat the damage to the nerve by arte al beating in posterior fossa is a safe and effective therapy.