大脑中动脉狭窄或闭塞显微手术治疗单中心经验并文献复习

目的 探讨颞浅动脉-大脑中动脉(STA-MCA)搭桥术治疗成人大脑中动脉狭窄或闭塞的疗效.方法 回顾性分析31例行STA-MCA搭桥术治疗的大脑中动脉狭窄或闭塞患者的临床资料,术前均行全脑血管造影(DSA)评价颈外动脉-颞浅动脉、颈内动脉、大脑中动脉的狭窄程度,CT灌注成像(CTP)评估脑血流灌注情况.手术采用经额颞入...

Microsurgical treatment of middle cerebral artery stenosis or occlusion:a single center experience and literature review

Objective To investigate the effect of superficial temporal artery-middle cerebral artery(STA-MCA)bypass in the treatment of MCA stenosis or occlusion.Methods The clinical and imaging data of 31 MCA stenosis or occlusion patients with STA-MCA bypass were analyzed retrospectively.All the 31 patients underwent digital subtraction angiography(DSA)to evaluate the stenosis degree of external carotid artery-superficial temporal artery,internal carotid artery,middle cerebral artery,and underwent CT perfusion(CTP)to evaluate cerebral blood flow perfusion.The operation was performed by STA-MCA M4 segment bypass via the frontotemporal approach.CT angiography(CTA)and CTP were conducted 5-7 days after operation to evaluate the patency of anastomosis and the changes of cerebral hemodynamics.Modified Rankin scale(mRs)was used to evaluate the neurological function before and after operation.Clinical and imaging follow-up were conducted regularly after discharge.Results Of the 31 patients,the initial symptoms of 11 cases were dizziness,7 were numbness and weakness of limbs,7 were language dysfunction and 6 were dyskinesia caused by transient cerebrovascular attack(TIA).Among the 31 patients,the decreased perfusion of 10 cases were cerebral lobes,15 were multiple cerebral lobes,6 were unilateral basal ganglia,12 were severe stenosis,6 were subtotal occlusion,13 were complete occlusion.20 were single vessel stenosis and 11 cases were multiple vessel stenosis.CT scan showed that there was no new infarction or hemorrhage in the operation area,and the intracranial condition was stable.CTA and CTP scan showed that the bypass vessels were unobstructed in 29 cases,and the cerebral perfusion was improved.Among the 31 patients,1 had poor healing of scalp incision,3 had dysphoria caused by high perfusion,3 had neurological dysfunction caused by low perfusion infarction,3 had improvement of limb muscle strength,4 had improvement of language dysfunction symptoms,and 6 with recurrent TIA before operation had no recurrence after operation.The other patients had no obvious complications,or clinical symptoms improvements.The mRs score of 31 patients after operation showed that the neurological function of was significantly improved than pre-operation,and the difference was statistically significant.Of the 31patients,23 were followed up.The mRs score showed that the neurological function of 23 patients was further improved.DSA or CTA and CTP showed that the bypass vessels were unobstructed,and cerebral perfusion was further improved than that at discharge.Conclusion STA-MCA bypass is an effective method for the treatment of MCA stenosis or occlusion,and it is helpful to improve the nerve function of patients.However,it needs to be further verified by large sample,multicenter and long-term follow-up.