血管搭桥治疗颅内复杂性动脉瘤(附39例报告)

目的 探讨应用血管搭桥治疗颅内复杂性动脉瘤的疗效.方法 39例颅内复杂性动脉瘤患者中11例患者有动脉瘤破裂,Hunt-Hess分级分别为I级和Ⅱ级.28例未破裂动脉瘤以头痛、脑神经压迫和脑缺血发病.用大隐静脉移植搭桥10例,桡动脉移植搭桥13例,颞浅动脉搭桥10例,枕动脉搭桥6例.搭桥动脉与接受动脉的血管吻合:大脑中动脉24例,小脑后下动脉5例,大脑后动脉P2段4例,大脑前动脉A2远端2例,椎动脉V5段2例,颈内动脉1例,小脑前下动脉1例.移植血管与供血动脉的吻合:颈外动脉19例,大脑中动脉8例,大脑前动脉A2段2例,椎动脉V3段2例,颈内动脉C2段1例,后交通动脉1例.另外6例枕动脉搭桥,无近心端血管吻合.在搭桥血管完毕后,将动脉瘤近心端和远心端的供血动脉结扎或夹闭,行动脉瘤孤立术.对19例有压迫脑神经或颅内占位的高颅压的患者,将动脉瘤切除.结果 35例术后恢复良好,3例出院后需要照顾,1例术后9 d死于脑干梗死.35例术后脑血管造影检查,34例移植搭桥血管畅通,动脉瘤消失;1例吻合血管未通,但无神经功能缺失表现.结论 血管搭桥可作为治疗难治性颅内复杂动脉瘤的有效方法 .

Bypass graft in the management of the complex aneurysms

Objective The purpose of this study was to use a high flow grafts bypass for giant and complex aneurysms. Method 39 patients with complex aneurysms were treated with use of graft bypass. 11 patients presented with subarachnoid hemorrhage referred to lower Hunt and Hess grade Ⅰ and Ⅱ , and 28 patients with unruptured aneurysms exhibited their headaches, symptom and signs of mass effect and neural compression, and cerebral ischemic deficits. 13 patients were bypassed with the radical arteries(RAG) ,10 patients were bypassed with the saphenous veins(SV) ,10 patients were interposed with superficial temporal arteries ( STA ) , and 6 patients were bypassed with the occipital arteries ( OA) . The graft vessel were anastomosed to the recipient of the middle cerebral artery ( MCA) in 24 cases, the PICA in 5 cases, the posterior cerebral artery in 4 cases, the anterior cerebral artery (ACA) in 2 cases, the vertebral artery ( V5) in 2 cases, the intracranial carotid arteries in 1 case, inferioanterior cerebellar artery in 1 case. The graft vessel were anastomosed with the donor external carotid arteries in 19 cases, the MCA in 8 cases, the ACA in 2 cases, vertebral artery(V3) in 2 cases, internal carotid arteries(C2) in 1 case, proximal A2 portion of the posterior communicating artery in 1 case, additional to 6 cases with the OA bypass without anastomosis of recipient vessel. The aneurysms were trapped after the graft had been completed in the series. Excision of aneurysm was carried out in 19 patients with mass effect and neural compression. Results 35 patients obtained back to their normal life, three patient needs to assist for his daily life and one death occurred related to the brain stem infarction. 35 patients were received the postoperative angiographies underwent,34 patients were confirmed with patency of the bypass graft and elimination of the aneurysms on angiographies, but one patient was unidentifiable with patency of the bypass graft on angiography. Conclusions Bypass graft should be an effective management for surgical treatment of giant or complicated aneurysms.