Extracranial-Intracranial Bypass and Vessel Occlusion for the Treatment of Unclippable Giant Middle Cerebral Artery Aneurysms
Extracranial-Intracranial Bypass and Vessel Occlusion for the Treatment of Unclippable Giant Middle Cerebral Artery Aneurysms
复制标题
DOI：
10.1227/neu.0b013e3182804381
复制
发表时间：
2013-03-01
期刊：
影响因子：
4.8
通讯作者：
Spetzler, Robert F.
中科院分区：
文献类型：
--
作者：
Kalani, M. Yashar S.;Zabramski, Joseph M.;Spetzler, Robert F.
背景技术背景：巨大大脑中动脉（MCA）动脉瘤给治疗带来了挑战。目的：回顾采用颅外-颅内（EC-IC）旁路和血管牺牲治疗不适合夹闭或血管重建的巨大MCA动脉瘤患者的结局。方法：我们回顾性分析了1983年至2011年在我们机构治疗的动脉瘤数据库。结果：确定了16例患者（11例男性，5例女性）。囊状动脉瘤10例，梭形动脉瘤4例，蛇形动脉瘤2例。动脉瘤主要累及M1段5例，M2段9例，M1和M2段均累及2例。行EC-IC旁路术包括13例颞浅动脉-MCA，1例隐静脉-MCA和2例桡动脉-MCA。术后旁路通畅率为93.8%（15/16）。有3例脑血管意外（18.8%），但无围手术期死亡（死亡率为0%）。平均随访时间为58.4个月（范围：1-265个月;中位数：23.5个月）。75%（12/16）的病例动脉瘤成功闭塞。在使用该治疗策略的3例病例中观察到少量残留，并对其进行了重新治疗。在接受部分远端闭塞治疗的第4例病例中，术后观察到通过动脉瘤的血流减少，但患者未接受进一步治疗。末次随访时，平均改良兰金量表和平均格拉斯哥结局量表评分分别为1.6（范围，1-4;中位数，1）和4.8（范围，3-5;中位数，5）。载瘤血管闭塞的EC-IC旁路可以提供一种具有可接受的发病率和死亡率的持久治疗形式。
BACKGROUND: Giant middle cerebral artery (MCA) aneurysms pose management challenges.OBJECTIVE: To review the outcomes of patients with giant MCA aneurysms not amenable to clipping or vessel reconstruction treated with extracranial-intracranial (EC-IC) bypass and vessel sacrifice.METHODS: We retrospectively reviewed a database of aneurysms treated at our institution between 1983 and 2011.RESULTS: Sixteen patients (11 males, 5 females) were identified. There were 10 saccular, 4 fusiform, and 2 serpentine aneurysms. The aneurysms predominantly involved the M1 segment in 5 cases, M2 in 9 cases, and both M1 and M2 in 2 cases. The EC-IC bypasses performed included 13 superficial temporal artery-MCA, 1 saphenous vein graft-MCA, and 2 radial artery grafts-MCA. The postoperative bypass patency rate was 93.8% (15/16). There were 3 cerebrovascular accidents (18.8%), but no perioperative deaths (0% mortality). The mean follow-up was 58.4 months (range, 1-265; median, 23.5 months). In 75% (12/16) of cases the aneurysms were occluded successfully. A small residual was noted in 3 cases with the use of this treatment strategy, and they were re-treated. In a fourth case treated with partial distal occlusion, reduced flow through the aneurysm was noted postoperatively, but the patient did not undergo further treatment. The mean modified Rankin scale and mean Glasgow Outcome Scale scores at last follow-up were 1.6 (range, 1-4; median, 1) and 4.8 (range, 3-5; median, 5), respectively.CONCLUSION: Giant MCA aneurysms are challenging lesions. EC-IC bypass with parent vessel occlusion can provide a durable form of treatment with acceptable rates of morbidity and mortality.