大脑中动脉分叉部动脉瘤不同类型的治疗策略

Classification and therapeutic strategy of the middle cerebral artery bifurcation

目的探讨大脑中动脉（MCA）分叉部动脉瘤不同类型的治疗方案。 方法回顾性分析2013年1月至2016年7月临沂市人民医院神经外科收治的118例MCA分叉部动脉瘤患者的临床资料。根据动脉瘤的解剖分型分别采取开颅夹闭术治疗（手术组，66例）和血管内治疗（介入组，52例）；根据影像学资料分为经典型（46例）、偏侧型（49例）和累及双干或多干型（23例）。对各型接受血管内或开颅夹闭治疗后的效果进行改良Rankin量表评分（mRS）和对比分析。 结果46例经典型MCA分叉部动脉瘤患者中，手术组27例，mRS评分为0～2分20例，3～5分7例；介入组19例，mRS评分为0～2分14例，3～5分5例，两种术式的临床预后比较差异无统计学意义（P〉0.05）。49例偏侧型MCA分叉部动脉瘤患者中，手术组21例，mRS评分为0～2分11例，3～5分10例；介入组28例，mRS评分为0～2分23例，3～5分5例，介入组患者的临床预后要优于手术组患者（P〈0.05）。23例累及双干或多干型MCA分叉部动脉瘤患者中，手术组18例，mRS评分为0～2分14例，3～5分4例；介入组5例，mRS评分为0～2分1例，3～5分4例，手术组患者的临床预后要优于介入组的患者（P〈0.05）。 结论对于经典型MCA分叉部动脉瘤的患者，两种治疗方式的疗效并无明显差异；对于偏侧型MCA分叉部动脉瘤的患者，血管内治疗的预后要优于开颅夹闭治疗，应优先选择血管内治疗；对于累及双干或多干型MCA分叉部动脉瘤，应采用开颅夹闭手术治疗。

ObjectiveTo investigate the anatomic classification and therapeutic strategy of the middle cerebral artery （MCA） bifurcation aneurysms. MethodsA retrospective analysis was conducted about the clinical data of 118 patients with MCA bifurcation aneurysms treated at Department of Neurosurgery, Linyi People＇s Hospital from January 2013 to July 2016. According to the way of treatment, all subjects were divided into the ligation group （66 cases） and intervention group （52 cases）. Based on the imaging data, the patients were divided into classical type （46 cases）, unilateral type （49 cases） and double- or multiple-trunks-involved type （23 cases）. The treatment outcome was assessed using the modified Rankin scale （mRS） and compared between different groups. ResultsAmong the 46 patients with classical type of MCA bifurcation aneurysms, 27 underwent ligation and the mRS scores were 0-2 in 20 cases and 3-5 in 7; 19 patients accepted interventional embolization and their mRS scores were 0-2 in 14 cases and 3-5 in 5. There was no statistically significant difference in clinical outcomes between the groups of surgical ligation and endovascular treatment （P 〉0.05）. Among the 49 patients with unilateral type of MCA bifurcation aneurysms, 21 underwent surgical ligation and the mRS scores were 0-2 in 11 cases and 3-5 in 10; 28 underwent interventional embolization and their mRS scores were 0-2 in 23 cases and 3-5 in 5. The clinical outcome of interventional embolization was better than that of surgical clipping （P〈0.05）. Among the 23 patients with double- or multiple-trunks-involved type of aneurysms, 14 patients underwent surgical clipping and the mRS scores were 0-2 in 7 cases and points and 3-5 in 7; 9 patients underwent endovascular embolization and the mRS scores were 0-2 in 4 cases and 3-5 in 5. The clinical effect of surgical clipping was better than that of interventional embolization （P〈0.05）. ConclusionsFor classical type of MCA bifurcation aneurysms, the 2 treatment methods had not significantly difference in the outcome. For unilateral type of MCA bifurcation aneurysms, the prognosis of interventional embolization seems better than that of surgical clipping. Surgical clipping might be more advantageous for double- or multiple-trunks-involved type aneurysms.