颅内外血管吻合联合血管内栓塞术治疗颅内前循环复杂动脉瘤

Extra-intracranial bypass in combination with endovascular embolization for the treatment of complex anterior circulation aneurysms

目的 观察颅内外血管吻合联合血管内栓塞术治疗颅内前循环复杂动脉瘤的手术适应证及疗效.方法 回顾性研究广西医科大学第四附属医院神经外科自2011年1月至2014年6月采用颅内外血管吻合联合延期（吻合术后1周）血管内部分栓塞术治疗的颅内前循环复杂动脉瘤患者,共16例.分析其手术适应证及治疗结果.结果 16例患者中,1例血管吻合术后出现癫痫大发作,1例出现术侧丘脑梗死,其余患者术后无神经功能缺损表现.出院临床随访12 ～18个月,术前头痛及视力下降的患者症状消失,丘脑梗死患者病情好转,其余患者病情稳定.6个月DSA检查显示,吻合血管通畅率为100％;其中3例海绵窦段动脉瘤患者术侧颈内动脉仍存在血流通过,但远端流速明显变慢,动脉瘤较术前缩小近1/2;其余患者载瘤动脉闭塞,动脉瘤消失.结论 颅内外血管吻合联合延期血管内部分栓塞术治疗颅内前循环复杂动脉瘤,疗效满意,并发症发生率和动脉瘤复发率低.

Objective To observe the efficacy and surgical indications of extra-intracranial vascular anastomosis （bypass） in combination with endovascular embolization for the treatment of complex anterior circulation aneurysms.Methods From January 2011 to June 2014,a total of 16 patients with complex intracranial aneurysm in internal carotid artery system treated with extra-intracranial vascular anastomosis （bypass） combined with delayed intravascular embolization at the Department of Neurosurgery,Guangxi Liuzhou Worker＆#39; s Hospital were enrolled retrospectively.Their treatment outcomes and surgical indications were analyzed.Results In the 16 patients,1 had grand mal epilepsy and 1 had thalamus infarction on the surgical side after vascular anastomosis （bypass）,and other patients did not have any neurological damage.Their clinical follow-up ranged from 12 to 18 months after discharge.The symptoms of the patients with preoperative headache and decreased vision disappeared.The conditions of patients with thalamus infarction were improved.The conditions of other patients were stable.DSA examination at 6 months showed that the anastomotic patency rate was 100%.The internal carotid arteries on the surgical sides still had blood flow passing through in 3 of the patients with aneurysm in the cavernous sinus segment,but the distal flow velocity was significantly slower.The aneurysms were reduced by nearly 1/2.The parent arteries of the remaining patients were occluded and the aneurysms disappeared.Conclusions The treatment outcomes of extraintracranial vascular anastomosis （bypass） in combination with delayed partial endovascular embolism for the aneurysms in complex internal carotid artery system are satisfactory.The incidence of complications and the recurrence rate of aneurysms are low.