显微手术治疗大脑中动脉分叉部巨大动脉瘤

【摘要】目的探讨大脑中动脉（MCA）分叉部巨大动脉瘤显微手术治疗的方法、处理技术及疗效。方法回顾性分析11例MCA分叉部巨大动脉瘤患者的临床资料。患者均为单发动脉瘤，平均直径为（22.0±10.9）mm；入院时Hunt-Hess分级Ⅰ级5例、Ⅱ级2例、Ⅲ级2例、Ⅳ级2例；均行开颅显微手术治疗。术后采用格拉斯哥预后量表（GOS）评分评估患者的预后。结果本组患者中，6例患者的动脉瘤行塑形夹闭，另外5例患者用联合颅外-颅内或颅内-颅内血管搭桥处理，其中3例患者行动脉瘤夹闭塑形联合颞浅动脉-大脑中动脉搭桥，1例患者行颞浅动脉-大脑中动脉双搭桥，1例患者行动脉瘤切除联合载瘤动脉端端吻合。术后CTA或/和DSA复查示，患者的动脉瘤均完全消失，4例颅内-颅外血管搭桥和1例颅内-颅内血管吻合患者桥血管均通畅。术后随访6~84个月，9例患者预后良好，无神经功能障碍，GOS评分4~5分；2例患者有轻度残疾。结论显微手术是治疗MCA分叉部巨大动脉瘤的主要方法，根据动脉瘤形态、解剖位置以及有无分支血管等特征，可以选择塑形夹闭和动脉瘤孤立或载瘤动脉近端阻断联合血管搭桥技术进行处理。

Abstract： Objective To investigate the method, treatment technology and curative effect of microsurgical treatment of giant aneurysms in the bifurcation of middle cerebral artery(MCA). Methods The clinical data of 11 patients with MCA bifurcation giant aneurysms were analyzed retrospectively. All patients were single aneurysms with an average diameter of(22.0±10.9) mm.At admission, hunt Hess classification showed grade Ⅰ in 5, grade Ⅱ in 2, grade Ⅲ in 2 and grade Ⅳ in 2. All patients underwent craniotomy and microsurgery. The prognosis of patients was evaluated by Glasgow prognosis scale(GOS). Results In this group, 6 patients underwent plastic clipping of aneurysms, and the other 5 were treated with combined extracranial-intracranial or intracranial-intracranial vascular bypass, of which 3 underwent plastic clipping of moving aneurysms combined with superficial temporal artery middle cerebral artery bypass, 1 patient underwent superficial temporal artery middle cerebral artery double bypass, and 1 underwent moving aneurysmectomy combined with end-to-end anastomosis of tumor carrying artery. Postoperative CTA or / and DSA showed that the aneurysms disappeared completely, and the bridging vessels were unobstructed in 4 cases of intracranial extracranial vascular bypass and 1 case of intracranial intracranial vascular anastomosis. The postoperative follow-up of 6-84 months showed 9 patients had a good prognosis and no neurological dysfunction, with GOS score of 4-5, and 2 patients had mild disability. Conclusions Microsurgery is the main method for the treatment of giant aneurysms in the bifurcation of MCA. According to the characteristics of aneurysm morphology, anatomical location and whether there are branch vessels, plastic clipping and aneurysm isolation or proximal occlusion of tumor carrying artery combined with vascular bypass can be selected for treatment.