中国现代神经疾病杂志 ›› 2021, Vol. 21 ›› Issue (7): 575-580. doi: 10.3969/j.issn.1672-6731.2021.07.008

• 血管搭桥术 • 上一篇    下一篇

2 外科手术治疗初次介入栓塞术后复发颅内动脉瘤

黄戈1, 孙杨1, 刘洁2, 佟小光3   

  1. 1 300070 天津医科大学神经内外科及神经康复临床医学院2019级;
    2 510630 广州, 暨南大学附属华侨医院神经外科;
    3 300350 天津市环湖医院神经外科
  • 收稿日期:2021-07-05 出版日期:2021-07-25 发布日期:2021-07-26
  • 通讯作者: 佟小光,Email:tongxg@yahoo.com
  • 基金资助:

    天津市科技计划项目（项目编号：18ZXDBSY00180）

Surgical treatment for recurrent intracranial aneurysms after primary interventional embolization

HUANG Ge1, SUN Yang1, LIU Jie2, TONG Xiao-guang3   

  1. 1 Grade 2019, Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China;
    2 Department of Neurosurgery, The First Affiliated Hospital of Ji'nan University, Guangzhou 510630, Guangdong, China;
    3 Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China
  • Received:2021-07-05 Online:2021-07-25 Published:2021-07-26
  • Supported by:

    This study was supported by Tianjin Science and Technology Plan Commission (No. 18ZXDBSY00180).

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摘要：

目的 探讨初次介入栓塞术后复发动脉瘤外科手术治疗的有效性和安全性。方法 纳入2014年6月至2019年6月在天津市环湖医院诊断与治疗的15例初次介入栓塞术后复发动脉瘤患者，动脉瘤分别位于前交通动脉（1例），大脑中动脉（MCA，2例），颈内动脉海绵窦段（1例）、床突上段（2例）和后交通段（5例），基底动脉（2例），小脑后下动脉（PICA，2例）；5例为巨大动脉瘤（直径> 25 mm），3例为大动脉瘤（直径10~25 mm），7例为小动脉瘤（直径< 10 mm）；均行外科手术治疗。结果 15例患者均成功实施外科手术，手术成功率为100%。7例行单纯开颅动脉瘤夹闭术；7例行血管搭桥术，包括颈外动脉-桡动脉-M2搭桥术（2例）、颞浅动脉（STA）-M4搭桥术（1例）、枕动脉-PICA搭桥术（2例）和STA-大脑后动脉（PCA） P2搭桥术（2例）；1例行颈内动脉开口缩窄术。术后13例预后良好[改良Rankin量表（mRS）评分≤ 2]，1例（例6）夹闭术后出现脑梗死，1例（例11） STA-PCA搭桥术后11个月死于肺部感染。结论 介入栓塞术后复发动脉瘤手术难度较高，推荐在动脉瘤夹闭术和血管搭桥术方面均有足够经验的医疗中心进行，血管搭桥术是处理复杂复发动脉瘤的有效手段。

关键词: 颅内动脉瘤, 复发, 栓塞, 神经外科手术

Abstract:

Objective To assess the efficacy and safety of surgical treatment for recurrent intracranial aneurysms after primary interventional embolization. Methods A total of 15 patients with recurrent aneurysms after primary interventional embolization who were diagnosed and treated in Tianjin Huanhu Hospital from June 2014 to June 2019 were included. The aneurysms located in anterior communicating artery (ACoA, one case), middle cerebral artery (MCA, 2 cases), internal carotid artery (ICA) cavernous sinus segment (one case), supra clinoid process segment (2 cases) and posterior communicating segment (5 cases), basilar artery (BA, 2 cases), posterior inferior cerebellar artery (PICA, 2 cases). There were 5 large aneurysms (> 25 mm in diameter), 3 large aneurysms (10-25 mm in diameter), and 7 small aneurysms (< 10 mm in diameter). Surgical treatment was performed on all patients. Results Surgery was performed successfully in all patients, with a success rate of 100%. Seven patients underwent bypass surgery[external carotid artery (ECA)-radial artery (RA)-M2 bypass (2 cases), superficial temporal artery (STA)-M4 bypass (one case), occipital artery (OA)-PICA bypass (2 cases), and STA-posterior cerebral artery (PCA) P2 bypass (2 cases)] and 7 patients underwent clipping surgery, and carotid narrowing surgery was performed in one patient. In 15 patients 13 (86.67%) had favorable outcome[modified Rankin Scale (mRS) ≤ 2]. One case (Case 6) had cerebral infarction after clipping. One case (Case 11) had no significant relief of compression symptoms after superficial temporal artery (STA)-posterior cerebral artery (PCA) low flow posterior circulation bypass, and died of pulmonary infection 11 months after follow-up. Conclusions Operations for recurrent aneurysms after interventional embolization are difficult surgery, such surgeries are recommended in high-volume centers, with sufficient experience in both clipping and cerebral bypass. Bypass surgery is an effective means of dealing with recurrent complex aneurysms.

Key words: Intracranial aneurysm, Recurrence, Embolism, Neurosurgical procedures

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