摘要：

目的: 探讨颅内-颅内血管搭桥术治疗基底动脉复杂动脉瘤的术式和适应证。方法与结果: 回顾2017年4月至2023年4月在天津市环湖医院行颅内-颅内血管搭桥术的6例基底动脉复杂动脉瘤患者的临床资料，3例为椎基底动脉延长扩张型动脉瘤，1例为基底动脉上段动脉瘤合并近端基底动脉重度狭窄，2例为基底动脉巨大型夹层动脉瘤；5例为破裂动脉瘤，Hunt-Hess分级Ⅴ级1例、Ⅳ级1例、Ⅲ级2例、Ⅱ级1例；1例为未破裂动脉瘤。6例患者均采用颅内-颅内血管搭桥术，主要包括颈内动脉岩骨段-桡动脉-大脑后动脉搭桥术联合动脉瘤夹闭术（1例）、椎动脉V3段-桡动脉-大脑后动脉搭桥术联合动脉瘤孤立术（4例）、大脑中动脉M2段-桡动脉-大脑后动脉P2段搭桥术联合动脉瘤孤立术（1例），均顺利完成手术。术后即刻复查影像学提示桥血管通畅，动脉瘤不显影，基底动脉上段显影良好。4例预后较好，改良Rankin量表（mRS）评分为0~3分；1例术前即为重症蛛网膜下腔出血（Hunt-Hess分级Ⅳ级），虽手术顺利，动脉瘤得以控制，但预后欠佳（mRS评分4分）；1例基底动脉干巨大型动脉瘤患者，术前存在蛛网膜下腔出血（Hunt-Hess分级Ⅴ级），虽手术顺利重建后循环并处理动脉瘤，仍于术后1周死亡。结论: 对于无法使用常规手段治疗的基底动脉复杂动脉瘤，颅内-颅内血管搭桥术能够为其提供较好的选择，临床根据实际情况选择合适术式。

关键词: 颅内动脉瘤, 基底动脉, 脑血管重建术

Abstract:

Objective: To explore the surgical procedures and indications of intracranial-intracranial bypass for the treatment of complex aneurysms in the basilar artery (BA). Methods and Results: A retrospective analysis was conducted on the clinical data and treatment process of 6 patients with complex BA aneurysms who underwent intracranial-intracranial bypass from April 2017 to April 2023 in Tianjin Huanhu Hospital. Among the 6 aneurysms, 3 were vertebro basilar dolichoectasia aneurysms, one was an aneurysm in the upper segment of BA combined with severe stenosis at the proximal of the aneurysm, and 2 were giant dissecting aneurysms of the BA. Among them, 5 were ruptured aneurysms, with one case of Hunt-Hess grade Ⅴ, one case of grade Ⅳ, 2 cases of grade Ⅲ, and one case of grade Ⅱ, while the remaining one case was an unruptured aneurysm. One patient underwent petrous segment of internal carotid artery (ICA)-radial artery (RA)-posterior cerebral artery (PCA) bypass combined with aneurysm clipping, 4 patients underwent V3 segment of vertebral artery (VA)-RA-PCA bypass combined with aneurysm trapping, and one patient underwent middle cerebral artery (MCA)-RA-PCA bypass combined with aneurysm trapping. Four patients had good prognosis, with modified Rankin Scale (mRS) 0 to 3, one case scored 4 and one case died one week after surgery. Conclusions: For complex aneurysms of the BA that cannot be treated with conventional methods, intracranial-intracranial bypass provides a good option. It is necessary to select the appropriate surgical procedure based on the actual situation in clinical practice.

Key words: Intracranial aneurysm, Basilar artery, Cerebral revascularization