椎基底动脉扩张延长症研究进展

椎基底动脉扩张延长症作为一种独立的脑血管病变,临床并不少见,其病因尚不明确,病理改变主要涉及颅内动脉中膜,血管的扩张、迂曲会使相邻结构受压、血流动力学发生改变、血栓形成及分支动脉受到牵拉,出现颅神经压迫症状及后循环缺血等临床表现。虽然针对椎基底动脉延长症尚无确切有效的治疗方法,但在外科手术、神经介入及对症治疗等方面有一定的研究进展。     

1例面肌痉挛合并椎基底动脉延长扩张症并文献复习

目的 报告1例面肌痉挛合并椎基底动脉延长扩张症（VBD）病例,提高对VBD的认识.方法 对1例合并VBD的面肌痉挛病人行手术治疗,并结合文献进行分析.结果 VBD是一种少见的血管异常性疾病,迂曲扩张的椎基底动脉压迫增加了面肌痉挛治疗的复杂性.结论 治疗面肌痉挛病人过程中应注意到其合并VBD的可能性,从而能够早期诊断和治疗.     

椎基底动脉扩张延长症1例报告

椎基底动脉延长扩张症（VBD）是一种少见的血管异常性疾病。由于基底动脉延长、扩张对脑神经、脑干的压迫以及供血区域脑缺血性改变,临床症状表现复杂、多样,易致漏诊、误诊。     

椎基底动脉延长扩张症165例临床特征分析

目的 探讨椎基底动脉延长扩张症(VBD)的临床特征.方法 回顾分析165例VBD患者的临床资料,并分析症状性与非症状性VBD的影响因素.结果 本组165例中男性105例,女性60例,平均年龄65±3岁.临床表现:后循环TIA61例,后循环梗死16例,脑干出血1例,前庭阵发症28例,三叉神经痛15例,面肌痉挛11例,无症状33例.CTA、MRA、DSA显示基底动脉不同程度的延长扩张、骑跨.VBD症状有无,与患者年龄、高血压病、糖尿病、吸烟、血管直径、延长扩张程度相关.结论 VBD临床表现复杂、多样;常见症状有卒中、压迫性症状和脑神经损害等,血管影像检查是重要的诊断依据.     

椎-基底动脉延长扩张症的诊疗进展

椎-基底动脉延长扩张症(vertebrobasilardolichoectasia, VBD)是临床少见的一种脑血管病,以椎动脉(vertebral artery, VA)和(或)基底动脉(basilar artery, BA)的管壁扩张、管道冗长且走行迂曲为主要特征。VBD最常见的临床表现是缺血性卒中,此外还可出现脑干或脑神经受压、脑积水、颅内出血等非特异性症状。该病预后差且尚无特效治疗手段,确诊主要依赖影像学检查。得益于检查技术的进步,近些年来该病的检出率有逐年升高的趋势。本文主要针对近些年来关于VBD的诊断和治疗取得的进展做综述如下。     

椎基底动脉延长扩张症伴基底动脉夹层动脉瘤致蛛网膜下隙出血一例

正患者男性,59岁,主因突发头晕伴行走不稳3 d,于2015年9月20日入院。患者3 d前跑步时无明显诱因突发头晕伴行走不稳,休息后症状加重并出现右眼视物模糊和右侧听力下降,当地医院行头部CT和MRI检查提示基底动脉延长扩张症伴动脉瘤,右侧小脑新发梗死(图1a,1b)。为求进一步手术治疗,遂至我院就诊。患者既往有高血压(高血压3级,极高危)20余年,血压最高达180/110 mm Hg(1 mm Hg=0.133 k Pa),规律服用硝苯地平20 mg/d,     

椎基底动脉延长扩张症一例

患者男性,31岁。因突发性晕厥伴双下肢无力3 h,于2013年11月4日入院。患者于运动中突发短暂性意识丧失伴双下肢抽搐,无头痛、恶心、呕吐,无视物不清,无语言理解、表达障碍。急诊行头部CT检查可疑脑血管畸形（图1）。既往无高血压病史、其他基础疾病病史和脑卒中家族史;4年前罹患“心肌梗死”,治疗后好转,未再发。入院后体格检查：血压170/110mmHg（1mmHg=0.133kPa）、呼吸20次/min、脉搏76次/min、心率70次/min。     

椎基底动脉延长扩张症伴梭形动脉瘤一例

椎基底动脉延长扩张症(vertobrobasilar dolichoectasia,VBD)是一种少见的血管病.随着影像技术的发展.本病检出率越来越高.发病原因为动脉硬化和变性改变,导致动脉中膜梭形扩张.患者男性,68岁,主冈头晕伴视物不清2月于2008年11月4日入住南京大学医学院临床医院神经内科.患者于2个月前无明显诱因出现头晕,间有走路不稳,无明显头痛、恶心呕吐,伴有视物模糊,但无明显复视;无明显感觉、运动障碍.在当地医院行头颅CT检查,考虑右侧桥小脑角占位.遂到我院求治.既往有高血压病史十余年,予以氨氯地平治疗,血压控制尚可.查体:血压160/95mmHg,神志清楚,语言流利.初测智能正常.     

椎-基底动脉扩张延长症致面肌痉挛的手术治疗

目的 探讨椎-基底动脉扩张延长症（vertebrobasilar dolichoectasia,VBD）导致面肌痉挛的临床特点及手术方法。方法 回顾性分析7例VBD导致的面肌痉挛的临床资料,3例行常规微血管减压术,4例采用“双面胶悬吊技术”。结果 术后随访6个月~2年,7例均恢复良好;6例面肌抽搐症状完全消失,1例有部分残留;2例出现一过性面瘫,1例出现一过性听力下降,1例出现永久性听力下降;无复发、脑脊液漏、颅内感染、死亡。结论 VBD导致的面肌痉挛手术治疗难度大,并发症多,采用“双面胶悬吊技术”能达到较好的疗效。     

36例椎基底动脉扩张延长症临床分析

椎基底动脉扩张延长症（VBD）是目前正处于研究和探索阶段的一种脑血管变异性疾病,动脉的延长扩张主要是指动脉血管的显著伸长、扩张、迂曲,随之出现血流动力学和凝血功能障碍形成血栓和微小栓塞,可伴或不伴动脉瘤形成,主要发生于椎动脉或基底动脉。国外研究报道,总体人群中VBD的发生率低于0.05%,范晓颖等对门诊常规CT扫描的患者进行统计发现,VBD的发生率0.6%,     

基底动脉侧向偏离弯曲情况临床病例对照观察

目的:调查接受头颅MRI和MRA检查者的基底动脉偏离、弯曲情况。方法:按时间顺序提取于2005年7月至2006年7月在我院核磁共振室同时进行头颅MRI和MRA检查的623人的影像资料,597人为患者,26人为健康体检者。参照Giang等的分类标准按4个等级统计基底动脉偏离、弯曲情况。结果:597例患者中,基底动脉0度偏离弯曲158例,占26.46%;1度289例,占48.40%;2度135例,占22.61%;3度15例,占2.51%。在26名正常体检者中,基底动脉0度偏离弯曲7例,占26.92%;1度17例,占65.38%;2度2例,占7.69%;3度0例。结论:在全部样本中基底动脉3度偏离弯曲者占2.4%。     

Weber综合征合并Claude综合征伴椎基底动脉延长扩张症1例：诊疗体会并文献复习

正脑干解剖结构致密,神经核团及纤维束交错纵横。Weber综合征和Claude综合征均为少见的脑干综合征,二者合并出现并不多见。椎基底动脉延长扩张症(vertebrobasilar dolichoectasia,VBD)是一种少见的以椎基底动脉显著增长、增粗和扭曲为特点的脑血管病,临床上多以后循环梗死就诊,尤其以脑干梗死居多,因其临床症状多隐匿,容易疏忽而漏诊。现将江苏省苏北人民医院神经内科诊治的1例Weber综合征合并Claude综合征伴VBD报道如下。     

12例基底动脉极度过长弯曲临床特点分析

目的研究基底动脉极度过长弯曲是否与头晕有关。方法收集作者医院住院的基底动脉弯曲患者12例,分析其临床表现。入组标准为经MRA检查显示基底动脉弯曲成半圆,其程度相当于Giang等关于基底动脉主干过长弯曲分类标准的2~3级。结果12例患者中有11例反复发生头晕(91%),1例无头晕者存在桥脑梗死。结论基底动脉极度过长弯曲者极易发生头晕。     

Vertebrobasilar Dolichoectasia Causing Symptomatic Hydrocephalus Due to Third Ventricular Compression

Vertebrobasilar dolichoectasia sometimes presents with symptoms related to mass effect like cranial nerve palsies, or with ischemia or hemorrhage. Symptomatic hydrocephalus as a complication of vertebrobasilar dolichoectasia is extremely uncommon. Furthermore, there are few cases of vertebrobasilar dolichoectasia, in which cerebrospinal fluid flow disorder mechanisms are clearly demonstrated in neuroimaging findings. Here, we describe a patient with vertebrobasilar dolichoectasia who presented with symptomatic hydrocephalus due to direct compression against the third ventricle, which was immediately relieved by ventriculoperitoneal shunt. This patient exhibited a progressive clinical course of acute hydrocephalus; however, a subclinical ventricular dilatation may have been present before the onset. Therefore, a careful follow-up is warranted to treat symptomatic hydrocephalus that may develop in patients with vertebrobasilar dolichoectasia.     

椎基底动脉延长扩张症与前循环障碍关系的研究(附5例报告)

目的观察椎基底动脉延长扩张症(VBD)与前循环障碍的关系。方法回顾性分析VBD与颈内动脉闭塞/狭窄并存病例的临床及影像学资料。结果 5例患者中,临床表现为双眼同向偏盲或视力障碍3例,一侧肢体运动障碍2例,Gerstmann综合征1例。CT/MRI显示分水岭性脑梗死(后型)2例,大脑前及大脑中动脉供血区梗死各1例,无明显改变1例;CTA/MRA显示同时伴有一侧颈内动脉闭塞3例,双侧颈动脉狭窄及发育不良(烟雾病)各1例;基底动脉长度为34.0~39.5 mm,直径为4.6~4.8 mm;颅内椎动脉最大处直径为4.4~4.8 mm。结论 VBD可与颈动脉闭塞或狭窄共存,临床表现更为复杂。长期的前循环障碍可能是VBD形成的重要促发因素,应兼顾前后循环状况制定治疗方案。     

Neurofibromatosis Type 1 Associated with Vertebrobasilar Dolichoectasia and Pontine Ischemic Stroke

Neurofibromatosis type 1 (NF1) is a heterogeneous, common, neurocutaneous disorder presenting different complications during a life span, including cerebrovascular dysplasia. To our knowledge this is the first reported case of NF1 associated with vertebrobasilar dolichoectasia and pontine ischemic stroke. We describe a 57‐year‐old man with NF1 who presented an acute onset right‐sided facial palsy and hemiplegia, dysarthria, and gait imbalance. Magnetic resonance imaging showed an acute left paramedian pontine infarct and a hypoplastic right vertebral artery. Brain Computed Tomography Angiography revealed the occurrence of vertebrobasilar dolichoectasia. Co‐occurrence of VBD and NF1 might not be merely casual and it may significantly heighten the mortality rate in this multisystem disorder. We suggest a possible role of VBD in the genesis of our patient's clinical‐radiological features and prompt the early detection of asymptomatic arteriopathy in individuals with NF1 in order to ameliorate patients’ quality of life and life expectancy.     

The Effect of Microvascular Decompression for Hemifacial Spasm Caused by Vertebrobasilar Dolichoectasia

Objective

Hemifacial spasm (HFS) caused by vertebrobasilar dolichoectasia (VBD) is very rare, and in theses cases, it is difficult to decompress the nerve from its vascular compression. The objective of this study was to investigate the outcome of microvascular decompression (MVD) for HFS caused by VBD.

Methods

There were 10 patients of HFS caused by VBD at our hospital between September 1978 and September 2008. We evaluated magnetic resonance angiography (MRA) and time of flight magnetic resonance imaginge (TOF MRI) findings using the criteria for VBD. We compared the clinical outcomes of MVD for the 10 patients with VBD with the overall outcomes of the total 2058 MVDs performed for HFS.

Results

The results of MVD for HFS caused by VBD were successful in 90.9% of cases. The postoperative complication rate in VBD was 45.5%. Offending vessels in patients with VBD were identified visually during surgery. Adverse effects after MVD were found in 4 patients. We found that the diameter of VBD was significantly greater in patients with complications than in those with no complications (p=0.028).

Conclusion

Our data shows that MVD may be a good treatment modality for HFS caused by VBD but care must be taken to avoid adverse effects from the procedure. It is important to detach the dolichoectatic artery from its surrounding structures sufficiently to allow it to be easily movable. In addition, attempts should be made to lessen the retraction of the cerebellum during release of the dolichoectatic artery.     

Study on the Correlation between different Levels of Patients with Vertebrobasilar Dolichoectasia and Posterior Circulation Blood Perfusion

ObjectiveThis study investigates the differences and changing trend of posterior circulation blood perfusion between different levels of vertebrobasilar dolichoectasia(VBD) patients. The relationship between the deviation of the basilar artery(BA) in different directions and the location of pontine infarction are also investigated.MethodsA cohort of 106 patients(74 males and 32 females) who satisfied the diagnostic criteria for VBD were recruited for this study and classified according to the bifurcation height and the deviation position of the BA, as well as the measured blood perfusion value of the pontine, which includes rCBF, rCBV, MTT, and TTP.ResultsOut of the 106 patients, 19 cases were classified as Level 1, 74 cases were classified as Level 2, and 13 cases were classified as Level 3. The different levels between the VBD groups were statistically significant (P<0.05, P<0.01), and it was found that as the level increases, rCBF and rCBV gradually decreased, while MTT and TTP gradually increased. The statistic results of different perfusion parameters were also significant, when pairwise comparisons between Level 1 and Level 3, and Level 2 and Level 3 were performed. However, when comparing Level 1 and Level 2, only the TTP showed significant result. Among 106 patients, 22 cases had brainstem infarction, 13 cases had left brainstem infarction, 8 cases had right brainstem infarction, and 1 case had brainstem infarction on both sides. Brainstem infarction generally occurs on the opposite side of the direction of BA deviation(P<0.05). Regardless of the BA was deviated to the left or right, perfusion analysis showed that there was significant difference in blood perfusion on both sides of the pontine when BA is deviated(P<0.05, P<0.01). The rCBF and rCBV on the contralateral side of deviation were lower than those on the same side, and the MTT and TTP were longer than those on the same side. There were 37 cases with vertebral artery dominance(VAD), 16 cases with left VAD, and 21 cases with right VAD. Statistical analysis showed that BA was more likely to deflect to the opposite side of the dominant artery(P<0.05), and compared with non-VAD, there was no significant difference in pontine blood perfusion (p>0.05).ConclusionAs VBD level increases, rCBF and rCBV will gradually decreases while MTT and TTP showed sign of increasing. The location of brainstem infarction is opposite to the direction of the BA deviation, and BA is more likely to deviate to the opposite side of the dominant artery.