Abstract:

Objective: To explore the efficacy and advantages of intracranial-intracranial bypass for the treatment of complex intracranial aneurysms. Methods: A total of 9 patients with complex intracranial aneurysms who underwent intracranial-intracranial bypass in Xiangya Hospital of Central South University from February 2014 to May 2020 were included, and were treated with grafts bypass or reimplantation of recipient arteries. All cases underwent CTA or DSA to detect the patent of grafts, whether aneurysms were completely clipped or resected and aneurysms recurrence occurred during the follow-up. Modified Rankin Scale (mRS) was used to evaluate the neurological prognosis at discharge and during the follow-up. Results: Radial artery (RA) or great saphenous vein (GSV) was used for interposition in 4 cases, and recipient arteries were used for reimplantation in 5 cases. Of 4 cases of interposition, the cavernous sinus seoment of internal carotid artery (ICA)-GSV-ICA bypass was adopted in one case, middle cerebral artery (MCA) M2-RA-M2 bypass in one case, anterior cerebral artery (ACA) A3-GSV-A3 bypass in one case, posterior cerebral artery (PCA) P2-RA-P2 bypass in one case. Of 5 cases of reimplantation, MCA M2 inferior trunk was reimplanted to M2 superior trunk in one case, ACA A3 was reimplanted to contralateral A3 in 2 cases, the posterior inferior cerebellar artery (PICA) was reimplanted to the anterior inferior cerebellar artery (AICA) in 2 cases. CTA in 3 d postoperatively showed all cases grafts were patent and aneurysms disappeared. After 3 months of discharge, 2 were lost to follow-up. The other 7 cases kept the patency of grafts and no new aneurysms, and were constantly followed up, with an average follow-up time of 30.71 months, and mRS score was 1 or lower. Conclusions: Intracranial-intracranial bypass can be applied for complex intracranial aneurysms that are difficult for conventional surgical treatment to solve. Compared with extracranial-intracranial bypass, its grafts are shorter and its hemodynamics features are more in line with physiological conditions.

Key words: Intracranial aneurysm, Cerebral revascularization, Radial artery, Saphenous vein

摘要：

目的: 探讨颅内-颅内血管搭桥术治疗复杂颅内动脉瘤的疗效。方法: 纳入2014年2月至2020年5月在中南大学湘雅医院行颅内-颅内血管搭桥术的9例复杂颅内动脉瘤患者，采用桥血管移植搭桥或传出动脉（受体动脉）再植术。术后行CTA或DSA检查桥血管通畅情况、动脉瘤夹闭或切除情况、随访期间检查动脉瘤新发情况；并于出院时及随访期间采用改良Rankin量表（mRS）评估神经功能预后。结果: 采用桡动脉（RA）或大隐静脉（GSV）移植桥血管4例，传出动脉（受体动脉）再植术5例，分别为大脑中动脉M2-RA-M2搭桥术1例、大脑前动脉A3-GSV-A3搭桥术1例、大脑后动脉P2-RA-P2搭桥术1例、颈内动脉（ICA）海绵窦段-GSV-ICA搭桥术1例、大脑中动脉M2下干-M2上干搭桥术1例、大脑前动脉A3-对侧A3搭桥术2例、小脑后下动脉-小脑前下动脉搭桥术2例。术后3 d复查CTA均显示桥血管通畅，未见动脉瘤显影；出院后3个月2例失访，余7例复查CTA或DSA均显示桥血管通畅，无动脉瘤新发；此7例患者长期随访，随访时间30.71个月，mRS评分均≤ 1分。结论: 颅内-颅内血管搭桥术适用于常规手术难以处理的复杂颅内动脉瘤等疾病，具有所需桥血管短、更符合生理状态血流动力学等优势。

关键词: 颅内动脉瘤, 脑血管重建术, 桡动脉, 隐静脉