成人烟雾病颅内出血部位及原因的MSCTA分析

MSCTA analysis of intracranial bleeding site and causes in adults moyamoya disease

目的:通过多层螺旋CT血管成像(MSCTA)探讨成人烟雾病(MMD)颅内出血的部位及原因。方法:搜集30例年龄>30岁的出血性MMD患者的临床及MSCTA资料并进行回顾性分析。结果:本组患者中脑叶出血6例,丘脑、基底节区出血15例,脑室内出血5例,蛛网膜下腔出血4例。MSCTA表现为①本组患者颈内动脉分叉以上均有不同程度的狭窄闭塞:双侧大脑中动脉狭窄闭塞20例,单侧10例;双侧大脑前动脉狭窄闭塞25例,单侧3例;双侧大脑后动脉狭窄闭塞7例,单侧3例;双侧颞浅动脉狭窄2例,单侧3例。②脑底动脉环、基底节区及病变血管周围异常增生血管网形成28例。③侧支代偿供血:大脑后动脉扩张形成软脑膜吻合支代偿22例;前交通动脉增粗,由健侧代偿供血10例;眼动脉扩张5例;颈外动脉分支动脉扩张形成穿膜支与颅内软脑膜动脉吻合8例。④合并脑动脉瘤形成11例。⑤脑出血与侧支循环的关系:15例丘脑、基底节区出血及5例脑室出血患者均见异常增生血管网;6例脑叶出血患者见软脑膜侧支代偿丰富,其中1例枕叶出血与大脑后动脉瘤破裂有关。结论:MMD出血以丘脑、基底节区及脑室出血多见。异常增生血管、扩张的侧支代偿动脉及动脉瘤破裂是脑出血的主要原因。

Objective：To investigate the locations and causes of intracranial hemorrhage in adult moyamoya disease by the use of MSCTA technology. Methods： Clinical data and MSCTA materials of 30 moyamoya patients at the age of 30 or above were retrospectively analyzed. Results：In this group, there were 6 cases of cerebral lobar hemorrhage, 15 cases of thalamus and basal ganglia region hemorrhage,5 cases of intraventricular hemorrhage, and 4 cases of subarachnoid hemorrhage. MSCTA manifestations：①All cases of this group showed different degree of stenosis and occlusion above the internal carotid bifurcation;20 cases showed stenosis and occlusion in bilateral middle cerebral artery and 10 cases unilateral;25 cases showed stenosis and occlusion in bilateral anterior cerebral artery and 3 cases unilateral; 7 cases in bilateral posterior cerebral artery and 3 cases unilateral;2 cases showed stenosis in superficial temporal artery and 3 cases unilateral. ②Abnormal vascular network developed around circle of Willis and basal ganglia region in 28 cases. ③Development of collateral circulation：dilatation of posterior cerebral artery with formation of collateral with leptomeningeal branches in 22 cases;dilatation of anterior communicating artery supplied from the contralateral anterior cerebral artery in 10 ease;dilatation of ophthalmic ar- teries in 5 case;dilalation of external carotid artery branches forming anastomosis with cerebral pial arteris in 8 cases. ④ development of cerebral aneurysm in 11 cases. @Relationship between cerebral hemorrhage and collateral circulation： we can see the abnormal vascular network developed in all cases （15 cases of thalamus and basal ganglia area hemorrhage and 5 ca ses of ventricular hemorrhage）. In 6 cases of cerebral lobar hemorrhage we can see rich piamater anastomosis branches,one of which showed that the bleeding in occipital lobe was due to the rupture of posterior cerebral artery aneurysm. Conclusion： Intracranial hemorrhage in adult moyamoya disease is mainly located in thalamus, basal ganglia region and ventricle. Abnormal vascular network,dilatation of collateral arteries and rupture of aneurysm are the main causes of intracranial hemorrhage.