复合手术在脑和脊髓血管病治疗中的初步应用

Preliminary experience of hybrid operation in the treatment of cerebral and spinal vascular diseases

目的探讨复合手术在脑和脊髓血管病外科治疗的临床效果。方法回顾性分析2017年1月至2018年6月郑州大学第一附属医院神经外科实施复合手术治疗的15例脑和脊髓血管病患者的临床资料。15例患者中有7例行急诊手术,8例行择期手术。5例颅内动脉瘤均采用开颅夹闭术,其中4例术中需要调整动脉瘤夹,1例行球囊辅助载瘤动脉临时阻断术,1例行挽救性颞浅动脉-大脑中动脉低流量搭桥术;5例颅内动静脉畸形均采用部分栓塞联合手术切除;4例硬脑(脊)膜动静脉瘘和1例颅内动静脉瘘采用瘘口夹闭术。采用格拉斯哥预后分级(GOS)评估预后。结果所有患者的复合手术均取得成功。5例颅内动脉瘤夹闭后无瘤颈残留,行挽救性颞浅动脉-大脑中动脉低流量搭桥术的患者吻合血管通畅;5例颅内动静脉畸形中有3例完全切除,术中造影发现2例有畸形团残留,继续手术治疗达到彻底切除。4例硬脑(脊)膜动静脉瘘和1例颅内动静脉瘘的患者中,仅1例术中造影提示瘘口有残留,需重新调整动脉瘤夹夹闭瘘口。15例患者出院时的GOS分级:Ⅴ级8例,Ⅳ级5例,Ⅲ级2例。患者随访3~18个月,平均(10.2±3.5)个月,均病情稳定,其中GOS分级Ⅴ级9例,Ⅳ级4例,Ⅲ级2例。结论复合手术是脑和脊髓血管病外科治疗的新模式,可提高手术的精准性和临床效果,有效降低并发症的发生率,初步应用安全可靠。

Objective To investigate the clinical effect of hybrid operation in the treatment of cerebral and spinal vascular diseases. Methods A retrospective analysis was made on the clinical data of 15 patients with cerebral and spinal vascular diseases who were admitted to Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from January 2017 to June 2018. Of the 15 patients, emergency surgery was performed in 7 patients and elective surgery in 8 patients. Five cases of intracranial aneurysms were treated with surgical clipping, in which 4 of them needed clip adjustment during operation, 1 case underwent temporary balloon-assisted parent artery occlusion and 1 case underwent salvage superficial temporal artery (STA)-middle cerebral artery (MCA) low flow bypass;5 cases of intracranial arteriovenous malformations were treated with partial embolization combined with surgical resection;and the 4 cases of dural arteriovenous fistula and 1 case of intracranial arteriovenous fistula were treated with fistula clamping. The patients' outcomes were assessed based on Glasgow Outcome Scale (GOS). Results All hybrid operations were successfully performed. The 5 cases of aneurysms were clipped with no residual neck, and the anastomotic vessel in the patient undergoing STA-MCA salvage bypass was patent. Among the 5 cases of intracranial arteriovenous malformations, 3 cases were resected totally, and 2 cases were found to have residual malformation mass by intraoperative angiography and the operation was continued to achieve complete resection in the end. Only 1 case of residual fistula was detected by intraoperative angiography of the 4 cases of dural arteriovenous fistula and 1 case of cerebral arteriovenous fistula. By adjusting the clip, the fistula was closed completely. The GOS grade of the 15 patients at discharge were: grade Ⅴ in 8 cases, grade Ⅳ in 5 and grade Ⅲ in 2. The patients were followed up for 3 to 18 months. The mean follow-up time was 10.2±3.5 months and their conditions were stable, including 9 cases with GOS grade Ⅴ, 4 cases with GOS grade Ⅳ and 2 cases with GOS grade Ⅲ. Conclusions Hybrid surgery is a new mode of surgical treatment for cerebral and spinal vascular diseases, which could improve the accuracy and effect of operation, effectively reduce the incidence of complications, and seems safe and reliable in our initial application.