低流量搭桥术治疗巨大型颈内动脉海绵窦段动脉瘤的临床疗效

The clinical effect of low-flow bypass surgery in the treatment of giant cavernous sinus aneurysms

目的探讨低流量搭桥术治疗巨大型颈内动脉海绵窦段动脉瘤的临床疗效。方法回顾性分析天津市环湖医院神经外科2013年5月至2018年8月收治的7例采用低流量搭桥术治疗的巨大型颈内动脉海绵窦段动脉瘤患者的临床资料。根据术前侧支循环的代偿情况决定手术方式, 其中6例行颈内动脉闭塞联合颞浅动脉-大脑中动脉搭桥术, 1例行颈内动脉缩窄联合颞浅动脉-大脑中动脉吻合术。术中采用荧光素血管造影和(或)血管超声检查评估桥血管的通畅情况。术后行影像学随访评估动脉瘤情况, 采用改良Rankin量表评分(mRS)评估患者的症状改善情况。结果 7例患者术中评估桥血管均通畅。术后1例患者发生脑梗死, 预后良好;无一例患者死亡。术后随访6~48个月, 随访期间未见动脉瘤复发或破裂出血, 6例动脉瘤消失, 1例动脉瘤缩小;mRS 0分者5例, 1分者1例, 3分者1例。结论初步观察显示, 低流量搭桥术治疗巨大型颈内动脉海绵窦段动脉瘤的临床效果好, 并发症少。

Objective To evaluate the effect of low-flow bypass surgery in the treatment of giant cavernous sinus aneurysms.Methods A retrospective analysis was conducted on the clinical data of 7 patients with giant cavernous sinus aneurysms treated by low-flow bypass surgery at the Department of Neurosurgery of Tianjin Huanhu Hospital from May 2013 to August 2018.The surgical method was determined according to the compensation of the collateral circulation before the operation:6 cases underwent ICA occlusion+STA-MGA anastomosis,1 case underwent ICA constriction+STA-MCA anastomosis.Intraoperative fluorescein angiography and/or vascular ultrasound were used to assess the patency of the graft vessels.Postoperative imaging follow-up was performed to assess the aneurysm condition,and the modified Rankin scale(mRS)was used to assess the improvement of the patients'symptoms.Results Intraoperative assessment indicated the patency of the graft vessels in 7 patients.Cerebral infarction occurred in 1 patient after the operation,and the outcome was good;none of the patients died.The postoperative follow-up period was 6 to 48 months.During the follow-up period,no recurrence or rupture of aneurysm was observed,the aneurysm disappeared in 6 cases,the aneurysm shrank in 1 case.The mRs score was 0 in 5 cases,1 in 1 case,and 3 in 1 case.Conclusion Preliminary observations show that low-flow bypass surgery for the treatment of giant cavernous sinus aneurysms has a good clinical effect and few complications.