摘要
目的探讨蛇形动脉瘤的手术治疗方法。方法21例蛇形动脉瘤中，14例未破裂动脉瘤，主要症状为头痛4例、可逆性脑缺血发作3例、颈项强直和后组脑神经压迫5例、视野缺损1例、癫痫发作1例；有动脉瘤破裂的7例中，Hunt—HessⅠ级和Ⅱ级6例、Ⅲ级1例。病程从20d至3．5年，平均7．3个月。动脉瘤位于大脑中动脉M1段6例，M2段近端4例；大脑前动脉A1段1例，A2段近端1例；大脑后动脉P1段2例；基底动脉主干2例，椎动脉5例。动脉瘤直径0．3～2．5cm，平均1．2cm。13例动脉瘤长3．0cm以上，8例动脉瘤长5．0cm以上。桡动脉移植搭桥7例，颞浅动脉搭桥6例，枕动脉搭桥6例，大隐静脉移植搭桥2例。12例为颅内外动脉搭桥，供血动脉为颈外动脉5例，枕动脉4例，颌内动脉3例。接受动脉为大脑中动脉5例，小脑后下动脉3例，大脑后动脉P2段3例，小脑前下动脉1例。9例为动脉瘤近端与远端间的血管间插入移植搭桥，包括大脑中动脉M1与M2段间的插入移植搭桥3例，M1段间的搭桥2例，大脑前动脉A1远端与A2近端插入搭桥2例，椎动脉颅内与颅外端间搭桥2例。在搭桥外血管完毕后，11例行动脉瘤孤立术；7例行动脉瘤切除；3例仅将动脉瘤近心端阻断，保护穿通动脉开通，避免缺血发生。结果20例术后恢复良好，包括头痛缓解，癫痫局部发作或大发作消失，肢体活动障碍的改善和视力的恢复。1例出院时需要照顾。术后脑血管造影检查，19例移植搭桥血管畅通，动脉瘤消失；1例吻合血管未通，但无神经功能缺失表现；1例颅内外搭桥后，术后第2天手术部位出现血肿，手术清除血肿，术后肢体肌力Ⅳ级。结论对于单纯手术无法夹闭的蛇形动脉瘤，通过适当血管搭桥或插入性移植的方法可得到满意的效果。
Objective The purpose of this study was to use graft bypass for giant serpentine aneurysms. Method 21 patients with giant serpentine aneurysms were treated with the use of graft bypass. Out of 14 patients with unruptured aneurysms, 4 patients presented with headache, 3 with reversible ischemic neurologic deficit（RIND） , 5 patients had neck stiffness and features of lower cranial nerve palsy and out of the remaining two each had epilepsy and visual fields deficits respectively. 7 patients compromised ruptured aneurysms, inclusive of six patients with Hunt - Hess grade Ⅰ and Ⅱ , and one grade Ⅲ. Their suffering course ranged from 20 days to 3.5 years（ mean, 7.3 months）. Cerebral angiography disclosed the M1 segment aneurysms of the middle cerebral artery in 6 patients and M2 segment in 4 patients, A1 segment aneurysms of the anterior cerebral artery in 1 patients and A2 segment in l patient, PI segment aneurysm of the posterior cerebral artery in 2 patients, basilar trunk in 2 patients, and the vertebral aneurysms in 5 patients. The aneurysm size in diameter from 0. 3 to 2. 5 cm（mean diameter, 1.2 cm） , 13 aneurysms had length of more than 3.0 cm and 8 patients with serpentine aneurysms had more than 5.0 cm. We used radial artery graft in 7 patients, superficial artery graft（STA） in 5 patients, occipital artery（OA） in 6 patients and greater saphenous vein（GSV） in remaining 2 patients. We underwent extra- intracrania] bypass in 12 patients which includes external carotid artery to intracranial artery bypass in 5 cases, occipital artery to intracranial artery bypass in 4 cases and internal maxillary artery to intracranial artery bypass in 3 cases. The recipient intracranial vessel were anastomoscd to the middle cerebral arteries in five patients, to the inferiopostrior cerebellar arteries in three patients, to P2 segment of the posterior cerebral arteries in three patients, and to anterioposterior cerebellar artery in one patient. The interposed grafts were performed between the arteries
出处
《中华神经外科杂志》
CSCD
北大核心
2011年第9期905-909,共5页
Chinese Journal of Neurosurgery
关键词
颅内动脉瘤
脑血管重建术
血管移植
搭桥
Intracranial aneurysm
Cerebral revascularization
Vessel graft
Bypass
