神经影像学评价颅内外血管搭桥术的疗效

Evaluation of extra-intracranial bypass with neuro-imaging

目的:探讨神经影像学在颅内外血管搭桥术评价中的作用.方法:收集首都医科大学宣武医院神经外科2003年3月～2004年1月行颞浅动脉-大脑中动脉(STA-MCA)搭桥术病人共10例,其中烟雾痛3例,颈内动脉闭塞2例,大脑中动脉闭塞3例,颈内动脉合并大脑中动脉狭窄1例,颈内动脉闭塞合并大脑中动脉狭窄1例,所有病人术前均行脑血管造影、MR灌注成像(perfusion weighted imaging PWI)和SPECT脑血流(rCBF)检查,行SPECT脑代谢(18F-FDG)检查7例,术后复查脑血管造影9例、MR灌注成像6例、SPECT脑血流+脑代谢检查6例.结果:术前PWI示相对脑血流(rCBF)降低1例、达峰时间(TTP)延迟5例、相对脑血流降低伴达峰时间延迟4例,术后1～2周复查PWI示好转1例、略有好转5例;术前SPECT检查示脑血流降低8例、大致正常2例,脑代谢大致正常3例、略减少3例、明显减少1例,术后SPECT检查示脑血流改善5例、脑代谢改善3例;术后复查脑血管造影9例示吻合口均通畅.结论:随着现代技术逐步发展,评价颅内外搭桥术方法多样化,脑代谢检查是目前认可的重要手段之一.

Objective The value of neuro-imaging was discussed in the evaluation of extra-intracranial bypass. Methods To collect 10 cases of STA-MCA bypass from March 2003 to January 2004 in the Department of Neurosurgery of Xuanwu Hospital, of all patients,3 cases of moyamoya diseases,2 cases of ICA occlusion,3 cases of MCA stenosis, 1 case of ICA and MCA occlusion,1 case of ICA occlusion with MCA stenosis. Before operation all patients were performed with DSA, PWI and SPECT·rCBF,7 cases were performed with SPECT·18F-FDG, after operation 9 cases were performed with DSA, 6 cases were performed with PWI,6 cases were performed with SPECT·rCBF+18F-FDG. Results Before operation PWI showed that 1 case decreased rCBF,5 cases delayed TTP, 4 cases decreased rCBF and delayed TTP, within 1~2 weeks of postoperation 1case good PWI,5 cases mild PWI; before operation SPECT showed that 8 cases decreased SPECT·rCBF, 2 cases were negative SPECT·rCBF,3 cases were negative SPECT·18F-FDG ,3 cases mild decreased SPECT·18F-FDG ,1 case greatly decreased SPECT·18F-FDG,after operation SPECT showed, 5 cases developed SPECT·rCBF,3 cases developed SPECT·18F-FDG,after operation DSA showed,9 cases anastomosis were unimpeded . Conclusion With the progress of modern technical,the method of evaluation of extra-intracranial bypass is varied and metabolic examination is one of the best important methods.