CLINICOPATHOLOGICAL FEATURES OF THE INTRACRANIAL ARTERY DISSECTION and VASA VASORUM

本研究是一项旨在探讨脑动脉夹层的特点和发病机制的临床病理和实验研究，尤其是动脉壁血管的发育和破裂。临床病理研究：对颅内夹层动脉瘤和颈动脉粥样硬化性闭塞症的病变进行了组织病理学研究。在这些不同临床类型的疾病中，常见的表现如下：1)动脉壁内出血伴中膜血管的丰富发育，2)血管壁交通中断伴壁内出血，3)病变周围进展性和局限性的动脉粥样硬化改变。从这些病理结果来看，…血管发育异常的晚期动脉粥样硬化改变的意义更多的中膜被怀疑是动脉壁夹层的一个致病因素。并在此基础上进行了颅内夹层动脉瘤的临床诊断和治疗研究。组织病理学研究旨在为后循环破裂动脉瘤的治疗提供更明确的指导。在本研究中，我们发现，在4例尸检病例中，有中膜和外膜分离的证据，但没有延伸到梭状型的扩张部分之外，而在侧突型则定位于动脉瘤的底部，因此侧突型的颈夹和梭状型的夹闭手术应该是根治性的治疗方法。#实验研究：曾尝试制作晚期动脉粥样硬化血管发育的动物模型，但未获成功。我们希望继续并完成实验研究。较少

This research is a clinicopathological and experimental study to investigate characteristic features and pathogenesis of the cerebral artery dissection, especially focusing on development and disruption of the intra-arterial wall vasa vasorum. The following results were revealed and presented in som papers.# Clinicopathological study : Histopathological studies of the lesions of the intracranial dissecting aneurysm and atherosclerotic occlusive disease of the carotid artery were studied. In these diseases of the different clinical categories, the following common findings were revealed ; 1) intra-arterial wall hemorrhage associated with rich development of the vasa vasorum in the media, 2)findings showing wall-disruption of the vasa vasorum communicating with intra-wall hemorrhage, 3)advanced and localized atherosclerotic changes around these lesions. Judging from these pathological findings, significance of advanced atherosclerotic changes with abnormal development of the vasa vasorum … More in the media were suspected to be a causative factor of the arterial wall dissections. Clincal study for true diagnosis and treatment of the intracranial dissecting aneurysms were also performed based on these pathological studies.# The histopathological study was aimed to give more clear guidance to the management of ruptured aneurysm of the posterior circulation. And in this study we found that, there was an evidence of dissection between media and adventitia, in the four autopsy cases, but not extended beyound the dilated portion in the fusiform type and localized at the base of the aneurysm in the lateral protrusion type and so surgical treatment by neck clipping in the lateral protrusion type and by trapping in the fusiform type should be a radical treatment.# Experimental study : Production of the animal model of advanced atherosclerosis with development of the vasa vasorum were tried, but this purpose were not succeed. We would like to continue and accomplish the experimental studies. Less