脑血管重建用于难治性颅内动脉瘤的治疗

Cerebral Revascularization in Treatment of Intractable Aneurysms

目的探讨难治性脑动脉瘤治疗中的脑血管重建适应证、手术技巧和临床疗效。方法自2000年起采用挠动脉作为移植血管进行颞浅动脉—挠动脉—大脑中动脉(STA-RA-MCA)搭桥手术,共治疗9例难治性动脉瘤患者。脑血管重建后采用颈部颈内动脉慢性阻断术或血管内介入治疗闭塞载瘤动脉或行动脉瘤孤立术。结果术后血管造影显示8例吻合血管通畅,并通过阻断载瘤血管而使动脉瘤不显影。1例吻合口狭窄伴血管痉挛。随访显示8例治愈患者无动脉瘤复发或破裂。结论脑血管重建,结合急性或慢性闭塞载瘤动脉是治疗难治性动脉瘤的有效方法;采用挠动脉作为移植血管行颅内外血管搭桥是目前较为合适和有效的脑血管重建技术。

Objective To evaluate the effectiveness of cerebral revascularization in the treatment of intractable aneurysms and to discuss the indications, surgical techniques, and the outcome of the revascularization. Methods During the recent 4-year period, 9 radical artery grafts were performed in patients with intractable or giant internal carotid artery(ICA)aneurysms. The indications for cerebral revascularization included parent vessel occlusion during the treatment of the intractable aneurysms with poor collateral circulation or the young patients. Modified techniques were taken to use the main trunk of superficial temporal artery(STA)as donor, while M3 branches near the bifurcation of the M2 segment of the middle cerebral artery(MCA)were chosen as the recipient arteries. STA-Radial artery(RA)-MCA bypass was followed by parent vessel occlusion via chronic cervical ICA ligation or balloon occlusion. Results Postoperative angiography demonstrated the patency of the grafts in eight cases. The procedure of the parent vessels occlusion was uneventful in these patients. Follow-up showed the patients were in excellent conditions after successful treatment of aneurysms. Significantly delayed filling of the graft was revealed in one patient, who could not tolerate balloon occlusion test and occlusion of parent artery failed. Conclusions Extracranial-to-intracranial bypass followed by parent vessel occlusion is a safe and effective method to treat intractable ICA aneurysms. Radical artery as graft can offer high-flow revascularization with less complications. Combined surgical and endovascular treatment might be the future direction for the treatment of the difficult aneurysms.