颞浅动脉-大脑中动脉搭桥术在缺血性脑血管病中的应用

Application of superficial temporal artery-middle cerebral artery bypass operation in ischemic cerebrovascular diseases

目的探讨颞浅动脉-大脑中动脉搭桥手术在缺血性脑血管病中的治疗应用及CT脑灌注成像对术前、术后脑血流量及手术效果的评价。方法选择2012年2月至2013年6月在山西医科大学第一医院神经外科进行颞浅动脉-大脑中动脉搭桥术的18例患者,脑血管造影或CT脑血管成像提示单侧血管闭塞或严重狭窄;术前行脑CT灌注成像,通过评估感兴趣区内相关指标,明确是否存在血流动力学改变。对脑血流动力学结果和临床表现进行综合评价,按照严格的纳入、排除标准选取患者进行颞浅动脉-大脑中动脉搭桥手术。术后复查脑血管造影或CT血管成像以及CT灌注成像,通过测量术后相关指标,与术前进行比较,评估手术患者的血管吻合口状况及血流动力学情况。应用美国国立卫生研究院卒中量表(NIHSS)对患者进行随访,评估患者手术前、后神经功能状况。所有收集的数据使用SPSS 13.0统计软件进行分析。结果 18例搭桥手术均顺利完成,术后CT灌注成像显示患侧脑血流量明显较术前升高(t=-6.443,P<0.05),平均通过时间明显减少(t=6.270,P<0.05),峰值时间也减少(t=3.574,P<0.05)。术后12周随访NIHSS评分较术前下降(t=3.310,P<0.05),神经功能症状有明显缓解。结论颞浅动脉-大脑中动脉搭桥术通过增加手术侧的脑血流量,可以在短期内缓解缺血区域的脑血流量,对于存在血流动力学改变的血管闭塞性疾病患者的神经功能症状有改善。CT灌注成像在颞浅动脉-大脑中动脉搭桥术术前评估及术后评价方面有一定的指导意义。

Objective To explore the therapeutic application of superficial temporal artery-middle cerebral artery（STA-MCA） bypass operation in ischemic cerebrovascular diseases and the value of cerebral CT perfusion imaging（CTP） on evaluation of preoperative and postoperative cerebral blood flow and surgical results. Methods Eighteen patients undergone STA-MCA bypass surgery in Department of Neurosurgery of the First Hospital of Shanxi Medical University,from February 2012 to June 2013 were enrolled in this study, with their digital subtraction angiography（DSA） or CT angiography（CTA） results showing unilateral vascular occlusion or severe stenosis. CTP was carried out preoperatively to verify whether hemodynamic changes exist or not. After the evaluation of the results of cerebral hemodynamics and clinical manifestations, patients were selected for STA-MCA bypass operation strictly according to inclusion and exclusion criteria. CTP and DSA or CTA were performed postoperatively. Compared with the preoperative results, the conditions of vascular anastomosis and hemodynamics of surgical patients were evaluated by measuring related indicators. All the patients were followed up and their neurological deficit before and after the operation were evaluated by the National Institute of Health Stroke Scale （NIHSS）. All collected data were analyzed by statistical software SPSS 13.0. Results STA-MCA bypass operation was completed successfully in all 18 patients. Postoperative CTP showed ipsilateral cerebral blood flow was significantly increased （ t = - 6. 443, P 〈 0.05 ）, the mean transit time decreased markedly （ t = 6. 270, P 〈 0. 05 ）, and the time to peak also reduced （ t = 3. 574, P 〈 0. 05 ）. The NIHSS scores of 12 weeks after operation decreased（t =3. 310,P 〈0. 05） ,and their neurological symptoms obviously improved. Conclusion STA-MCA bypass operation could increase the cerebral blood flow of surgical side, alleviate the cerebral blood flow in ischemic region in the short term, and improve the neurological symptoms of patients suffering from the vascular occlusive disease with hemodynamic changes. To a certain extent, CTP plays a role in guiding the assessment before and after STA-MCA bypass surgery.