Abstract:

Background: Complex intracranial aneurysms are one of the most difficult cerebrovascular diseases to treat, and even experienced cerebrovascular surgeons face great challenges. Intracranial-intracranial bypass with interposition graft has its unique surgical indications and technical points, but there is a lack of research reports in the literature at home and abroad. Methods: Six patients with complex intracranial aneurysms who were cured by intracranial-intracranial bypass with interposition graft from January 2015 to December 2023 in The First Medical Center of PLA General Hospital were enrolled, DSA was used to evaluate the patency of postoperative grafts and aneurysm development, modified Rankin Scale (mRS) was used to evaluate the neurological prognosis, and the procedure-related complications such as cerebral infarction, intracranial hemorrhage, scalp nonunion, and forearm nerve dysfunction were recorded. Results: All 6 patients successfully completed intracranial-intracranial bypass with interposition graft, with superficial temporal artery (STA) in 5 cases and radial artery (RA) in one case. The grafts were embedded between the proximal and distal parent arteries in 2 cases, and the grafts were bridged between the distal donor and proximal donor in 2 cases, one case was reconstructed in a "Y" shape between the artery and the recipient artery, one case was reconnected proximally to the donor artery, and the distal end was anastomosed with the branch end-to-end. Postoperative DSA showed all aneurysms disappeared and the grafts were unobstructed. The average postoperative follow-up was 23.67 months, and there was no recurrence of aneurysms and grafts occlusion, and the mean mRS score was 0.33 at the last follow-up. There were no surgery-related complications after surgery. Conclusions: Intracranial-intracranial bypass with interposition graft is an effective method for the treatment of complex intracranial aneurysms, which has the technical advantages of strong flexibility, abundant variants and wide range of indications, and can provide more abundant, safe and effective individualized treatment strategies for cerebrovascular surgeons.

Key words: Intracranial aneurysm, Cerebral revascularization, Microsurgery, Temporal arteries, Radial artery

摘要：

研究背景: 复杂颅内动脉瘤是最难治疗的脑血管病之一，即使是经验丰富的脑血管病外科医师也面临巨大挑战。嵌入桥接式颅内-颅内血管搭桥术具有独特的手术适应证和技术要点，但目前国内外文献缺乏报道。方法: 纳入解放军总医院第一医学中心2015年1月至2023年12月采用嵌入桥接式颅内-颅内血管搭桥术治疗的6例复杂颅内动脉瘤患者，采用脑血管造影评估术后桥血管通畅情况和动脉瘤显影情况，采用改良Rankin量表（mRS）评估神经功能预后，记录病程中有无脑梗死、颅内出血、头皮不愈合、前臂神经功能障碍等手术相关并发症。结果: 6例患者均顺利完成手术，桥血管采用颞浅动脉者5例，桡动脉者1例；2例桥血管嵌入载瘤动脉近端与远端之间，2例桥血管桥接于远端供体动脉与受体动脉之间，1例以“Y”形再造分叉，1例近端再接于供体动脉，远端与分支端端吻合。术后复查脑血管造影显示动脉瘤均消失，桥血管均通畅；术后平均随访23.67个月，未见动脉瘤复发和桥血管闭塞，末次随访时平均mRS评分为0.33分。术后未发生手术相关并发症。结论: 嵌入桥接式颅内-颅内血管搭桥术是治疗复杂颅内动脉瘤的有效方法，具有很强的灵活性、丰富的变型式和广泛的适应证等技术优势，可以为脑血管病外科医师提供更丰富、安全、有效的个体化治疗策略。

关键词: 颅内动脉瘤, 脑血管重建术, 显微外科手术, 颞动脉, 桡动脉