原位间置搭桥术治疗颅内复杂动脉瘤18例

In situ interposition bypass surgery in treatment of complex intracranial aneurysm:a report of 18 cases

目的:探讨原位间置搭桥术在颅内复杂动脉瘤中的应用。方法:回顾性分析2015年7月至2022年9月,在天津医科大学神经内外科及神经康复临床学院神经外科用原位间置搭桥术治疗的18例颅内动脉瘤患者的临床资料。动脉瘤分别位于大脑中动脉(MCA)14例,大脑前动脉(ACA)2例,小脑后下动脉(PICA)1例,大脑后动脉(PCA)1例;间置移植血管分别取自桡动脉(RA)14例,颞浅动脉(STA)3例,枕动脉(OA)1例;所有患者均行动脉瘤切除后端-端吻合原位间置搭桥,其中间置血管形态为I型13例,V型3例,Y型2例。术后均行数字减影血管造影(DSA)或CTA复查,采用格拉斯哥结果量表(GOS)评估患者预后,并定期采用门诊、电话或网络随访。结果:2例患者术后出现偏瘫;1例出现短暂的失语,3个月后完全恢复;其余15例患者未出现新的神经功能障碍。术后DSA检查结果显示,1个吻合口术后重度狭窄,其余吻合口及移植血管均通畅,所有动脉瘤均未显影;随访3~89个月,无动脉瘤复发,GOS评分5分16例,3分2例。结论:原位间置搭桥技术是治疗部分颅内复杂动脉瘤的一种安全有效的选择。

Objective To investigate the application of in situ interposition bypass surgery in the treatment of complex intracranial aneurysms.Methods A retrospective analysis was conducted on the clinical data of 18 patients with complex intracranial aneurysms treated by the in situ interposition bypass at the Department of Neurosurgery of Clinical College of Neurology,Neurosurgery and Neurorehabilitation,Tianjin Medical University from July 2015 to September 2022.Fourteen aneurysms were found being located in the middle cerebral artery(MCA),2 in anterior cerebral artery(ACA),1 in posterior inferior cerebellar artery(PICA)and 1 in posterior cerebral artery(PCA).Fourteen bypass surgery were with radial artery(RA)vessel grafts,3 with superficial temporal artery(STA)vessel grafts and 1 with occipital artery(OA)vessel graft.All patients underwent a surgical procedure of in situ interposition bypass with end-to-end anastomosis after resection of the aneurysms.I-type grafts were applied in 13 bypasses,V-type grafts in 3 bypasses,and Y-type grafts in 2 bypasses.All patients had undergone postoperative Digital subtraction angiography(DSA)or CTA reviews.Glasgow Outcome Scale(GOS)was used to assess postoperative outcome.Scheduled postoperative follow-ups were conducted on all patients.Results Two patients suffered hemiplegia after surgery.One patient had transient aphasia and it recovered in 3 months.No new neurological dysfunction was observed in the rest of patients.Postoperative DSAs showed good patency of the anastomoses and grafted vessels,except one anastomosis that had a severe stenosis,and no aneurysm was shown.The follow-ups lasted for 3 to 89 months and no recurrence of aneurysm was observed.Sixteen patients achieved GOS score 5 and 2 with GOS score 3.Conclusion In situ interposition bypass surgery is a safe and effective procedure for the treatment of complex intracranial aneurysms.