You Position: Home > Paper
Graft bypass surgery for giant and complex aneurysms
( views:269, downloads:109 )
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF NEUROSURGERY
- Issue:
- 5
- DOI:
- 10.3760/j.issn:1001-2346.2007.05.019
- Key Word:
- 动脉瘤;血管搭桥;血管移植
Abstract： 目的 探讨中、高流量血管搭桥方法对颅内巨大颅内动脉瘤的治疗.方法 8例巨大和颅底复杂动脉瘤患者,主要表现头痛发病者5例,视力减退者2例,面部麻木者1例.未破裂动脉瘤6例,2例患者发生动脉瘤破裂,Hunt-Hess分级分别为Ⅰ级和Ⅱ级.血管造影证实:动脉瘤体位于颈内动脉海绵窦段(C4段)4例、床突上段(C1段)2例、大脑中动脉M2～M1段者2例动脉瘤大小为2.5～6.0 cm,平均直径3.7 cm.其中6例动脉瘤为梭形,2例为宽颈动脉瘤.8例患者均采用额颞开颅,骨瓣要尽可能低到颅底,以缩短搭桥移植血管在颅外走行长度.通常用7-0显微缝线吻合移植血管与颈外动脉,用8-0缝线吻合移植血管与颅内段颈内动脉和大脑中动脉.4例患者利用大隐静脉移植搭桥,4例患者利用桡动脉移植搭桥.颅内、外搭桥完毕后将动脉瘤近心端和远端的供血动脉结扎和夹闭,阻断动脉瘤的全部血供.对3例有压迫脑神经或颅内占位引起颅压高的患者,将动脉瘤切除.结果 5例术后头痛消失,1例视力减退者明显改善,1例动眼神经麻痹恢复.5例术后行脑血管造影检查,3例行CT血管造影检查,7例搭桥吻合血管全部畅通,动脉瘤消失.2例术后出现暂时性一侧肢体力弱,肌力在Ⅱ～Ⅲ级之间,术后1个月完全恢复.结论 中、高流量颅内外血管搭桥可作为治疗颅内巨大动脉瘤的有效方法.
- [1]史继新,王汉东,杭春华,等.前循环巨大动脉瘤的手术治疗[J].2001,(2).
- [2]许百男,周定标,余新光,等.颅内复杂动脉瘤的手术治疗[J].2001,(2).
- [3]陈劲草,于加省,何跃,等.颅内复杂动脉瘤的手术治疗[J].2006,(11).
- [4]Michael J. Alexander,A. Giancarlo Vishteh,Robert F. Spetzler.Bypass surgery in the management of complex aneurysms[J].1999,2(3).
- [5]刘承基主编.脑血管外科学[M].2000.
- [6]van der Zwan A,Golay X,van der Grond J,etc.Altered flow territories after extracranial-intracranial bypass surgery.[J].2005,57(3).
- [7]ol.com,Olding M,Sekhar LN,etc.Cerebral revascularization using radial artery grafts for the treatment of complex intracranial aneurysms: techniques and outcomes for 17 patients.[J].2001,49(3).
- [8].Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. The EC/IC Bypass Study Group.[J].1985,313.
- [9]Lawton, M. T.,Spetzler, R. F..Surgical Strategies for Giant Intracranial Aneurysms[J].1999,72(1).