血流重建结合动脉瘤孤立术治疗前循环复杂动脉瘤的疗效分析

Revascularization combined with aneurysm trapping for complex anterior circulation aneurysms:an efficacy analysis

目的：探讨大脑中动脉（MCA）血流重建结合颅内动脉瘤孤立术治疗前循环复杂动脉瘤的临床疗效。方法：对14例载瘤动脉远端侧支循环代偿不良的前循环复杂动脉瘤患者,行大脑中动脉血流重建和动脉瘤孤立术。依据动脉瘤部位的不同,选择不同的血流重建方式,包括对M2段及其远端的动脉瘤采用低流量旁路移植5例,对M1段动脉瘤采用中流量旁路移植4例,对颈内动脉颅内段动脉瘤采用高流量旁路移植5例。术中或术后行脑血管造影和血管超声检查,以了解吻合口通畅与否及动脉瘤闭塞状况。本组患者随访期为2～60个月。结果：低和中流量旁路移植的9例患者术后经过顺利,术后造影示吻合口均通畅。5例高流量旁路移植的患者中3例术后经过顺利,2例术后即刻出现新的神经功能障碍,超声检查显示移植的血管内血栓形成。再次手术取栓后,神经功能障碍1例完全恢复,另1例大部分恢复;术后复查造影示4例吻合口通畅,1例吻合口不通。结论：大脑中动脉血流重建结合动脉瘤孤立术是治疗载瘤动脉远端侧支循环代偿不良的前循环复杂动脉瘤的有效方法,应根据动脉瘤部位和侧支循环状态,可选择高、中、低不同流量的旁路移植术式。

Objective To investigate the clinical efficacy of middle cerebral artery （MCA） revascularization combined with aneurysm trapping in the treatment of complex intracranial anterior circulation aneurysms. Methods Fourteen patients with insufficient distal collateral circulation of the parent artery were treated with revascularization and aneurysm trapping. Different bypass surgeries were selected according to the location of aneurysms including low （5 patients）, moderate （4 patients） and high （5 patients） blood flow bypass surgeries. Postoperative follow-up was 2 to 60 months. Results Nine patients who received low and moderate blood flow bypass surgeries recovered well, and digital subtraction angiography （DSA） showed that the anastomotic stomas were all patent. Postoperative DSA of the five patients who received high blood flow bypass surgeries showed that the anastomotic stomas in four of the five patients were patent, and one was obstructed. Three of that four patients recovered well after the procedures, and two developed new neurological deficits. Ultrasonic examination showed thrombosis in the grafted vessels. After re-operation for removing the thrombi, one patient recovered completely, and the other recovered well. Conclusion MCA revascularization combined with aneurysm trapping are the effective approach for the treatment of complex intracranial anterior circulation aneurysms with insufficient distal collateral blood flow. Bypass surgery with high, middle or low blood flow should be selected according to the location and collateral circulation status of the aneurysms.