摘要： 目的 探讨颅内外血管吻合或搭桥联合动脉瘤孤立术治疗颅内巨大型复杂动脉瘤的术式选择及适应证。方法 回顾分析2008 年2 月-2011 年12 月经脑血管造影术明确诊断的12 例颅内巨大型动脉瘤患者术前评价方法及手术治疗经过。结果 12 例患者中颈内动脉系统巨大型动脉瘤6 例（4 例位于颈内动脉海绵窦段或床突段、2 例位于颈内动脉交通段），大脑中动脉巨大型动脉瘤3 例，后循环动脉瘤3 例。其中7 例术前MR 灌注成像显示载瘤动脉远端组织存在明显缺血，选择行颞浅动脉?大脑中动脉低流量血管吻合术；5 例载瘤动脉远端组织供血正常，且搭桥血管长度较长（≥ 15 cm）、术前球囊闭塞试验呈阴性、患侧压颈脑血管造影侧支循环充盈不良患者，行高流量颅内外血管搭桥术。11 例术后神经功能缺损程度评价良好，改良Rankin 量表评分0 ~ 3 分；1 例术后4 分，3 个月后改善至3 分。结论 对于无法施行塑形夹闭术的颅内复杂巨大型动脉瘤患者，颅内外血管吻合或搭桥联合动脉瘤孤立术是其可选择的最后方法；而MR 或CT 灌注成像观察载瘤动脉远端组织供血正常与否，是选择不同流量血管吻合或搭桥术的关键。枕动脉、颞浅动脉或桡动脉为常用搭桥血管。

关键词: 颅内动脉瘤, 蛛网膜下腔出血, 脑血管重建术

Abstract: Objective To explore the selection and indication of intracranial-extracranial vascular anastomosis or bypass and trapping treatment for complex giant intracranial aneurysms. Methods The pre-operative assessment and surgical procedure of 12 patients with giant intracranial aneurysm admitted from Feb. 2008 to Dec. 2011 were analysed. Results There were 6 patients with internal carotid aneurysm (4 at cavernous sinus and clinoid process segment, and 2 at communicating branch), 3 with middle cerebral artery aneurysms, and 3 with posterior circulation aneurysms. Seven patients whose pre-operative MR perfusion imaging (MRP) showed obvious ischemia at the distal region of parent artery underwent superfical temporal artery-middle cerebral artery (STA-MCA) low flow vascular anastomosis. Five patients with rather long grafting vessel (≥ 15 cm) presented normal blood supply at the distal region of parent artery, pre-operative balloon occlusion test (BOT) negative, and insufficient filling of collateral circulation on cerebral angiography after compressed the neck of the affected side. These patients underwent intracranial-extracranial high flow vascular bypass. The outcome of 11 patients was good (modified Rankin Scale, 0-3), while the other was poor (modified Rankin Scale, 4). Conclusion Intracranial-extracranial vascular anastomosis or bypass and trapping treatment sometimes is the final option for complex intracranial aneurysms. Whether the blood supply at distal region of parent artery is normal or not will be the key to the selection for different flow vascular bypass (or anastomosis). Occipital artery, superfical temporal artery, and radial artery are commonly used as grafting vessels.

Key words: Intracranial aneurysm, Subarachnoid hemorrhage, Cerebral revascularization