颅内外搭桥和颈内动脉球囊闭塞联合治疗颅内巨大宽颈动脉瘤

Combined extracranial-intracranial bypass and balloon occlusion of internal carotid artery for the treatment of intracranial wide-neck giant aneurysms

目的 报告并评价联合应用颅内外搭桥和颈内动脉球囊闭塞术治疗 2例颅内巨大宽颈动脉瘤和长期随访结果。方法 对近 4年中联合应用颅内外搭桥和载瘤动脉球囊闭塞术治疗的 2例巨大宽颈动脉瘤的治疗和随访结果进行回顾性分析。结果 2例巨大不规则形动脉瘤 ( 1例位于左颈内动脉C1、2段和大脑中动脉M 1段 ,另 1例累及右颈内动脉岩段至右大脑中动脉M1和大脑前动脉A1段 )球囊闭塞试验阳性。先行颞浅动脉 大脑中动脉搭桥术 ,术后次日行脑血管造影证实吻合口通畅后 ,用可脱性球囊在动脉瘤近端闭塞颈内动脉。治疗后并随访 3～ 4年 ,病人无任何神经系统症状出现。CT示 2例动脉瘤均有血栓形成 ,1例可见动脉瘤缩小。血管造影示吻合口通畅 ,大脑中动脉分支显影良好 ,无动脉瘤显影。结论 联合应用颅内外搭桥和载瘤动脉球囊闭塞术 。

Objective To present and evaluate the treatment and longperiod followup of intracranial broad neck giant aneurysms treated by extracranialintracranial bypass and balloon occlusion of internal carotid artery. Methods Retrospectively analyze the treatment and longperiod followup result of 2 wideneck giant aneurysms treated by combined extracranialintracranial bypass and balloon occlusion of internal carotid artery during recent 4 years. Results The aneurysm located at C1、C2 segment of LICA and M1 segment of LMCA; the other involved petriol segment from of RICA to M1 of RMCA and A1 of RACA. The occlusion test in all 2 cases were positive. We first made bypass between the supersficial temporal artery and ipsilateral MCA. The cranial angiography was followed the next day to prove the patency of the bypass. Then the proximal segment of the ipsilateral ICA was occluded by using detachable balloon. After treatment and during 4year followup period, two patients showed no neurological deficits and CT scan showed thrombi within the lumens. The volume of one aneurysm decreased sharply. Cerebral angiography of the bypasses were patent and the no opacification of aneurysm any more. Conclusions Combined extracranialintracranial bypass and balloon occlusion of internal carotid artery is an alternative method for treating the aneurysm not to be cured by the interventional method and surgical operation.