出血性烟雾病合并颅内动脉瘤的治疗方式探讨(附13例病例报道)

Surgical treatment of the hemorrhagic moyamoya disease associated with intracranial aneurysms (the report of 13 cases)

目的探讨出血性烟雾病合并颅内动脉瘤患者的治疗方式。方法回顾性分析华中科技大学同济医学院附属同济医院神经外科自2016年4月-2018年4月共收治的13例出血性烟雾病合并颅内动脉瘤患者的临床资料。结果13例患者中共发现13个动脉瘤,其中8个动脉瘤为主干动脉型,5个为外周动脉型;所有动脉瘤均为责任动脉瘤;表现为蛛网膜下腔出血8例,脑室内出血3例,基底节出血破入脑室2例。8例合并主干动脉型动脉瘤患者均行弹簧圈栓塞治疗,其中有2例患者后期行血管重建术;5例合并外周动脉型动脉瘤患者,其中1例早期行予Onyx胶栓塞治疗,后期行血管重建术,2例行开颅动脉瘤夹闭及血管重建术,另外2例早期行保守治疗,后期行血管重建术。8例烟雾病合并主干动脉型动脉瘤患者经弹簧圈栓塞术后,5例达到致密栓塞,3例瘤颈部分残余;5例烟雾病合并外周动脉型动脉瘤患者中2例行开颅动脉瘤夹闭及血管重建术治疗,动脉瘤夹闭完全,1例行Onyx胶栓塞术后未见动脉瘤残留,未出现新鲜梗死灶,2例早期保守治疗,后期行血管重建术患者复查,其中1例动脉瘤稳定,另外1例动脉瘤消失。13例患者术后临床症状较术前均有不同程度的改善或恢复。结论临床上出血性烟雾病合并颅内动脉瘤患者并不少见,根据动脉瘤的类型采取不同的治疗方式和积极的治疗措施能达到更好的治疗效果。

Objective To explore the treatment modality of the hemorrhagic moyamoya disease associated with intracranial aneurysms.Methods The clinical data of 13 patients with hemorrhagic moyamoya disease associated with intracranial aneurysms in neurosurgery department of Tongji hospital from May 2016 to May 2018 were retrospectively analyzed.Results 13 aneurysms of the 13 patients were found,including the type of main artery involved in8 aneurysms,the type of peripheral artery involved in5 aneurysms.Each was responsible for the bleeding.CT scan showed SAH in8 patients,intraventricular hemorrhage in3 patients,basal ganglia hemorrhage broken into the ventricles in 2 patients.8 patients of main artery involved were treated by interventional therapy with coils and 2 cases of them were received STA-MCA bypass after endovascular therapy. 5 patients of peripheral artery involved were treated by onyx embolization in1 case and conservative therapy in 2 cases,then all of them received STA-MCA bypass in late period,while 2 cases received surgical clipping and STA-MCA bypass in one-stage.Among the 8 patients of main artery involved after endovascular therapy,Raymond I was achieved in5 patients,and RaymondⅡ was achieved in3 patients.Among the 5 patients of peripheral artery involved,the aneurysm was totally clipped in2 surgical cases,no aneurysm left and newly infarction area in 1 case by onyx embolization.1 aneurysm was stable and 1 aneurysm disappeared after STA-MCA bypass in two cases by conservative treatment.The symptom of all the 13 cases were improved to some extent compared with the preoperative state.Conclusion The hemorrhagic moyamoya disease associated with intracranial aneurysms was not uncommon.Different and active treatment measures could achieve better effect according to the type of associated aneurysm.