摘要
目的 探讨颅内-颅内血管搭桥侧侧吻合术治疗复杂颅内动脉瘤的长期疗效。方法 纳入2015年1月至2023年12月由中国医科大学附属第一医院神经外科同一术者实施颅内-颅内血管搭桥侧侧吻合术的5例复杂颅内动脉瘤患者,2例累及大脑前动脉A2段,3例累及大脑中动脉M2段。术中采用吲哚菁绿荧光血管造影术(ICGA)、术后采用CTA或DSA评估动脉瘤闭塞和血流重建情况;术后1周、3个月和末次随访时采用改良Rankin量表(mRS)评估神经功能预后;术后第1天、1周和3个月行头部CT和(或)MRI检查,评估是否发生出血性或缺血性并发症。结果 本组5例复杂颅内动脉瘤均孤立确切,2例行A3-A3侧侧吻合术;3例行M2-M2侧侧吻合术,其中1例在M2-M2侧侧吻合术基础上获取桡动脉(RA)作为桥血管,联合M1-RA-M2嵌入桥接式血管搭桥术。术中经ICGA证实,5例侧侧吻合口和1例M1-RA-M2桥血管均通畅。术后随访时间为23(14,71)个月,5例术后1周和术后3个月CTA或DSA检查、3例术后9~12个月DSA检查均未见动脉瘤显影,5例侧侧吻合口和1例M1-RA-M2桥血管均通畅。术后1周mRS评分较术前升高0~3分(1例手术前后均为4分、1例增加2分、1例增加3分),2例未破裂患者术后1周mRS评分无变化(均为1分);术后3个月mRS评分均下降(0分2例、2分1例、3分2例);末次随访时1例失访,余4例mRS评分进一步下降(0分2例、1分1例、2分1例)。术后无脑出血或脑缺血事件发生。结论 颅内-颅内血管搭桥侧侧吻合术的短期和长期通畅性良好,长期疗效稳定,是复杂颅内动脉瘤手术治疗的可靠技术。
Objective To explore the long-term outcome of intracranial-intracranial side-to-side bypass for complex intracranial aneurysms.Methods Five patients with complex intracranial aneurysms underwent intracranial-intracranial side-to-side bypass performed by the same surgeon at The First Hospital of China Medical University from January 2015 to December 2023 were included.Two cases involved the A2 segment of anterior cerebral artery(ACA)and 3 cases involved the M2 segment of middle cerebral artery(MCA).Indocyanine green angiography(ICGA)was used intraoperatively,and CTA or DSA was used postoperatively to evaluate aneurysm occlusion and blood flow reconstruction.The modified Rankin Scale(mRS)was used to evaluate the neurological prognosis at one week,3 months and the last follow-up.CT/MRI examination was completed on the first day,one week and 3 months after operation to evaluate whether hemorrhagic or ischemic complications occurred.Results Five cases of complex intracranial aneurysms were all occluded accurately.Two cases underwent A3-A3 side-to-side anastomosis,and 3 cases underwent M2-M2 side-to-side anastomosis,among which one case added M1-radial artery(RA)-M2 intracranialintracranial bypass with RA as graft on the basis of M2-M2 side-to-side anastomosis.During the operation,ICGA confirmed that the side-to-side anastomosis and M1-RA-M2 bypass were unobstructed in 5 cases.The postoperative follow-up time was 23(14,71)months.No aneurysm was found in cerebrovascular imaging examination one week and 3 months after operation in 5 patients,and 9 to 12 months after operation in 3 patients.Five side-to-side anastomosis stomas and one M1-RA-M2 graft were all unobstructed.At one week after operation,the mRS increased by O-3 score compared with that before operation(4 score maintained unchanged before and after operation in one case,2 score increased in one case,and 3 score increased in one case).In 2 unruptured cases,the mRS score was 1 score at one week after operation,and there was no change from that before operation.At
作者
刘源
佟志勇
余冠东
赵旭东
初金刚
LIU Yuan;TONG Zhi-yong;YU Guan-dong;ZHAO Xu-dong;CHU Jin-gang(Department of Neurosurgery,The First Hospital of China Medical University,Shenyang 11000l,Liaoning,China;Department of Radiology,The First Hospital of China Medical University,Shenyang 11000l,Liaoning,China;Department of Neurosurgery,The Second Hospital of Guangzhou Medical University,Guangzhou 510260,Guangdong,China)
出处
《中国现代神经疾病杂志》
CAS
北大核心
2024年第8期632-643,共12页
Chinese Journal of Contemporary Neurology and Neurosurgery
