颅内动脉瘤术中穿通支血管的保护

Intraoperative protection of perforating artery in the treatment of intracranial aneurysm.

目的探讨颅内动脉瘤手术中穿通支血管的处理方法和保护措施。方法回顾性总结18例颅内动脉瘤,术中根据动脉瘤位置和穿通支血管分布的不同,采取动脉瘤夹闭、动脉瘤近段阻断加架桥、动脉瘤孤立加架桥以及动脉瘤切除等方法处理动脉瘤。结果8例行动脉瘤直接夹闭术,4例行动脉瘤夹闭载瘤动脉重建,3例行动脉瘤孤立加颅内外血管架桥术,1例行载瘤动脉近端阻断远端血管架桥术,1例行动脉瘤切除术,1例行动脉瘤包裹术。术后全部复查头颅CT,1例患者出现穿通支血管损伤导致的缺血性脑梗死。结论对穿支血管的走行、分布、供应范围的深入理解及术中有效保护和正确处理穿通支血管对手术的效果起着重要作用,根据动脉瘤位置和穿支血管分布的不同,采取不同的手术方式。

Objective To explore practical method to protect perforating arteries m intracranial aneurysms. Method Clinical data of 18 intracranial aneurysms were retrospectively analyzed. Different surgical methods were chosen according to locations of aneurysms and distributions of perforating arteries including simple clipping, clipping with parent artery reconstruction, trapping with vessel revascularization, wrapping, and aneurysmectomy. Results 8 patients underwent simple clipping, 4 clipped with parent artery reconstruction, 3 trapped with vessel revascularization, 1 proximal ligated with vessel revascularization, 1 wrapped, and 1 underwent aneurysmectomy. All patients underwent CT scanning and only 1 patient had ischemic infarction postoperatively. Conclusions The understanding of the distribution, supplying territory, and clinical manifestation of important perforating arteries is paramount importance. Effective protection and correct management of perforating arteries play an important role in the surgical outcome. Different surgical methods should be adopted according to impotamt different configurations of aneurysms and perforating arteries.