后循环介入术后合并基底动脉尖综合征

Top of basilar artery syndrome after interventional treatment of posterior circulation

目的探讨后循环介入术后发生基底动脉尖综合征(TOBS)的发病率及患者临床特点和影像学表现。方法收集43例接受介入治疗的后循环病变患者的临床及影像学资料,对术后发生TOBS患者的临床症状、影像学表现等进行回顾,分析后循环介入术后TOBS发病率、发病机制、影像学特点及其临床表现。结果 43例中,6例(6/43,13.95%)发生TOBS,包括2例严重TOBS,其中1例动脉瘤介入栓塞后发生严重TOBS导致患者死亡,1例后循环动静脉畸形(AVM)介入术后发生严重TOBS,患者处于植物状态。TOBS患者术后1~7天出现急性颞叶、枕叶、顶叶、丘脑等梗死,CT平扫可见片状低密度影,MRI呈稍长T1稍长T2信号;栓塞畸形血管团责任血管后,部分供血区域内的血流灌注降低。结论介入术中发生TOBS的主要原因包括过度栓塞导致弹簧圈移位致使血管闭塞、术后脑水肿导致血管痉挛闭塞引发脑梗死、栓塞穿支血管等,影像学表现为颞顶枕区、小脑、丘脑等急性缺血表现。严重TOBS可致患者植物状态甚至死亡,但多数可通过营养神经、神经功能刺激等对症处理后得到缓解。

Objective To explore the incidence,imaging and clinical features of top of the basilar syndrome（TOBS）after posterior circulation intervention.Methods Clinical and imaging data of 43 patients who underwent posterior circulation intervention were collected.The incidence,imaging features and clinical manifestations of TOBS after intervention were analyzed.Results TOBS occurred in 6 patients（6/43,13.95%）,including 2 cases of severe TOBS and 4 cases of mild TOBS.One patient of aneurysm was found with severe TOBS after embolization and finally died,the other case of severe TOBS with posterior circulation arteriovenous malformations（AVM）became a plant man after intervention.Acute infarction of temporal lobe,occipital lobe,parietal lobe and thalamus occurred 1 to 7 days after intervention in patients with TOBS,among them low density lesions were observed on plain CT,while slightly longer T1 and longer T2 signals were observed on MRI.Blood supply in part of area reduced after intervention of responsibility vessel for malformation.Conclusion The main contributing factors of TOBS included vascular occlusion caused by excessive embolism which leading to coil displacement,cerebral infarction caused by vasospasm after hydrocephalus,as well as ischemia on perforator artery blood supply area after embolization.Imaging manifestations appeares as acute ischemic of the temporal parietal occipital region,the cerebellum and the thalamus.Severe TOBS can lead to living as plant man or death,whereas most patients with mild TOBS can benefit from treatment of nutritional nerve and nerve function stimulation.