脑血运重建联合开颅手术一期治疗烟雾病合并破裂动脉瘤的疗效

Effect of cerebral revascularization combined with craniotomy in the treatment of moyamoya disease complicated with ruptured aneurysm

目的探讨脑血运重建联合开颅手术一期治疗合并破裂动脉瘤的烟雾病的安全性和疗效。方法回顾性纳入2016年6月至2018年3月河南省人民医院神经外科收治的5例合并破裂动脉瘤的烟雾病或烟雾综合征患者(共5个动脉瘤),所有患者均一期行颅内外血运重建术联合开颅动脉瘤夹闭术。术后对5例患者进行随访,随访内容为复查数字减影血管造影(DSA)和灌注加权成像(PWI),判断患者术后远期脑血运重建及动脉瘤的疗效;采用改良Rankin量表评分(mRS)和日常生活能力量表(ADL)评分,评估患者的神经功能恢复情况。结果5例患者的手术均成功。术中荧光造影显示,颅内动脉瘤不显影,桥血管均吻合通畅。5例患者术后复查CT,均未见新发出血灶,且均无感染、新发脑梗死或脑出血等并发症发生。5例患者的随访时间为(17.6±1.7)个月(6~21个月)。5例患者术后6个月复查DSA显示,动脉瘤不显影,桥血管通畅。随访期间,5例患者均未出现新发的神经功能缺损症状,且无高灌注出血或大面积脑梗死发生。至末次随访,5例患者的mRS为(1.4±1.0)分(0~3分);ADL为(76±12)分(55~90分)。结论脑血运重建联合开颅手术一期治疗合并破裂动脉瘤的烟雾病患者安全、短期疗效较好。

Objective To investigate the safety and efficacy of cerebral revascularization combined with craniotomy in the treatment of moyamoya disease with ruptured aneurysm. Methods Five patients with moyamoya disease or Moyamoya Syndrome complicated with ruptured aneurysms (5 aneurysms) were treated at Department of Neurosurgery, Henan Provincial People's Hospital from June 2016 to March 2018. All patients underwent extracranial and extracranial revascularization combined with craniotomy for aneurysm clipping. Five patients were followed up after operation. The results of follow-up were as follows: digital subtraction angiography (DSA) or perfusion weighted imaging (PWI) was used to evaluate the long-term cerebral revascularization and the effect of aneurysm. The recovery of neurological function was evaluated by modified Rankin scale (mRS) and activities of daily living scale (ADL). Results The operations of all 5 patients were successful. Intraoperative fluorescence angiography showed that the intracranial aneurysm did not develop and the bridge vessels were anastomosed unobstructed. No new blood foci were found in 5 patients with CT after operation and there were no complications such as infection, new infarction or bleeding. The follow-up time of 5 patients was 6 to 21 months, with an average of 17.6±1.7 months. DSA showed that the aneurysm did not develop and the bridge vessels were unobstructed in 5 patients at 6 months after operation. During the follow-up period, none of the 5 patients had any new neurological deficit symptoms, and there was no hyperperfusion hemorrhage or large-area cerebral infarction. At the last follow-up, the mRS of 5 patients was 0-3, with an average of 1.4±1.0. The ADL of 5 patients was 55-90, with an average of 76±12 at the last follow-up. Conclusion Cerebral revascularization combined with craniotomy seems safe and effective in the treatment of moyamoya disease with ruptured aneurysm.