颅内外血管搭桥术治疗颅内巨大型动脉瘤

目的 报告采用动脉瘤夹闭联合颅内外血管搭桥术治疗6例颅内巨大型动脉瘤患者的临床经过,探讨手术适应证及治疗效果.方法 回顾分析6例颅内巨大型动脉瘤患者颅内外血管搭桥术前血流动力学状态、搭桥方式,以及临床和影像学转归.结果 6例患者中3例施行动脉瘤夹闭、切除(或载瘤动脉重建)联合颞浅动脉.大脑中动脉搭桥术,3例行动脉瘤夹闭、切除(或孤立)联合高流量搭桥术(颈外动脉.桡动脉,大隐静脉.大脑中动脉搭桥术).手术后平均随访17个月,近远期脑血管造影和CT血管造影检查显示,搭桥血管及吻合口血流通畅;临床症状与体征得到不同程度改善,随访期间无急性出血性或缺血性脑血管事件发生.3例行联合低流量搭桥术患者远期改良Rankin量表评分2例0分、1例2分;3例联合高流量搭桥术患者远期改良Rankin量表评分1例0分、2例1分.结论 对于脑血管重建术可能牺牲载瘤动脉或远端大脑中动脉血流的颅内复杂动脉瘤患者,可根据具体情况联合各种颅内外血管搭桥术使血流得到有效代偿.脑血管造影联合CT灌注成像对颅内巨大型动脉瘤远端组织灌注状态及侧支循环评价具有一定参考价值.

Extracranial-intracranial bypass for giant intracranial aneurysms

Objective To report bypass treatment for 6 cases of giant intracranial aneurysm, and discuss the surgical indication and therapeutic effect. Methods A series of 6 patients with giant intracranial aneurysm underwent extracranial intracranial bypass. Pre operative cerebral hemodynamics, mode of bypass, and the clinical and imaging outcomes were analysed. Results Among 6 patients, 3 patients underwent trapping and resection (or parent vessel reconstruction) combined with low flow bypass while the other 3 patients underwent clipping (or trapping) combined with high flow bypass (external carotid artery radial artery/great saphenous vein middle cerebral artery bypass). The follow up period ranged from 6 to 28 months (mean 17 months). The short term and long term cerebral aniography and CT angiography showed the bypass vessel and anastomotic stoma were all patent. Signs and symptoms were improved in different degree. During follow up period, no acute hemorrhagic or ischemic cerebrovascular events occurred. Among 3 patients who underwent combined low flow bypass, the long term modified Rankin Scale (mRS) was 0 in 2 patients and 2 in one patient. Among the other 3 patients who underwent combined high flow bypass, the long term mRS was 0 in one and 1 in 2 patients. Conclusion Surgical treatment for complex intracranial aneurysm may sacrifice the parent vessel or the distal MCA branches. It is according to the patients condition and different intracranial extracranial vascular bypass which may effectively preserve the blood flow. Perfusion CT in combination with digital subtraction angiography can be used to evaluate distal perfusion status and collateral circulation in patients with giant intracranial aneurysm.