脑血运重建联合栓塞或开颅手术一期治疗烟雾病合并破裂动脉瘤的疗效

Cerebral revascularization combined with aneurysm clipping or embolization for the treatment of moyamoya disease complicated with ruptured aneurysms

目的观察脑血运重建联合栓塞或手术一期治疗合并破裂动脉瘤的烟雾病患者的安全性及短期疗效。方法回顾性连续纳入2015年12月至2017年10月南方医科大学南方医院神经外科于复合手术室内治疗的合并破裂动脉瘤的烟雾病患者，共5例（6个动脉瘤）。其中3例行开颅动脉瘤夹闭术，2例行血管内动脉瘤栓塞术，5例均一期行颅内外血运重建术。结果5例患者均成功手术，术中数字减影血管造影（DSA）检查显示，动脉瘤均无显影，桥血管吻合均通畅。术后5例患者均无新发神经功能缺损症状，MRI提示1例尾状核有小梗死灶，但无临床症状。5例临床随访5～24个月，末次随访均无出血及梗死事件发生，格拉斯哥预后评级V级4例，Ⅳ级1例；5例行MR血管成像检查，其中3例同时行DSA检查，均显示动脉瘤不显影，桥血管均通畅。结论复合手术室内行脑血运重建联合栓塞或开颅夹闭术一期治疗合并破裂动脉瘤的烟雾病患者，安全、短期疗效好。

Objective To evaluate the safety and short-term efficacy of cerebral revascularization combined with aneurysm clipping or embolization for the treatment of moyamoya disease complicated with ruptured aneurysms. Methods Five moyamoya patients （6 aneurysms） with ruptured aneurysnl underwent cerebral revaseularization combined with aneurysm clipping or embolization from December 2015 to October 2017 at Department of Neurosurgery, Nanfang Hospital, Southern Medical University. Two patients were treated by STA-MCA bypass combined with endovascular embolizatiou of aneurysm. Three patients （4 aneurysms） were treated with aneurysm clipping and EC-IC revascularization. Results Intraoperative DSA revealed total obligation of the 4 clipped aneurysms and the other 2 embolized peripheral aneurysms. All of the 5 bypass grafts showed good potency. The 5 patients recovered well after surgery ahhough 1 patient showed asymptomatic infarction on post-operative MRI. All patients received clinical follow-up （5-24 months） and were evaluated with the Glasgow outcome scale （GOS）. Five patients showed good outcome （GOS V or IV grade）. Five patients received MRA follow-up. Three oat of them received both DSA and MRA follow-up and showed no reoccurrence of aneurysm and good patency of the graft. Conclusion Cerebral revascularization combined with aneurysm clipping or embolization could be effective for moyamoya diseases with ruptured cerebral aneurvsms and showed good short-term results.