[1]黄河,刘志文,刘彬彬,等.颞浅动脉-大脑中动脉分流术在颅内复杂动脉瘤手术中的应用[J].中国临床神经外科杂志,2022,27(05):337-340.[doi:10.13798/j.issn.1009-153X.2022.05.001]
　HUANG He,LIU Zhi-wen,LIU Bin-bin,et al.Application of STA-MCA bypass to the surgical treatment of complex intracranial aneurysms: two cases report and literature review[J].,2022,27(05):337-340.[doi:10.13798/j.issn.1009-153X.2022.05.001]
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颞浅动脉-大脑中动脉分流术在颅内复杂动脉瘤手术中的应用()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年05期
页码:
337-340
栏目:
论著
出版日期:
2022-05-31

文章信息/Info

Title:
Application of STA-MCA bypass to the surgical treatment of complex intracranial aneurysms: two cases report and literature review
文章编号:
1009-153X(2022)05-0337-04
作者:
黄河; 刘志文; 刘彬彬; 王翼; 刘宁; 潘力; 杨铭; 宋健; 姚国杰; 马廉亭
430070武汉，中国人民解放军中部战区总医院神经外科/中国人民解放军神经外科研究所/国家级重点学科神经外科（黄河、刘志文、刘彬彬、王翼、刘宁、潘力、杨铭、宋健、姚国杰、马廉亭）
Author(s):
HUANG He;  LIU Zhi-wen;  LIU Bin-bin;  WANG Yi;  LIU Ling;  PAN Li;  YANG Ming;  SONG Jian;  YAO Guo-jie;  MA Lian-ting
Department of Neurosurgery, General Hospital of Central Theater, PLA, Wuhan 430070, China
关键词:
颅内动脉瘤; 颅内复杂动脉瘤; 颅内外血管分流术; 显微手术
Keywords:
Intracranial aneurysms;  Complex intracranial aneurysms;  Microsurgey;  STA-MCA bypass
分类号:
R743.9;R651.1+2
DOI:
10.13798/j.issn.1009-153X.2022.05.001
文献标志码:
A
摘要:
目的 探讨颞浅动脉（STA）-大脑中动脉（MCA）分流术在颅内复杂动脉瘤手术中的应用效果。方法 回顾性分析开颅夹闭术治疗的2例颅内复杂动脉瘤的临床资料。夹闭动脉瘤前，先行STA-MCA分流术。结果 1例破裂动脉瘤，DSA显示右侧颈内动脉后交通段巨大动脉瘤（责任动脉瘤）+左侧颈内动脉后交通段镜像动脉瘤，伴双侧胚胎型大脑后动脉，先行STA-MCA分流术，再行动脉瘤孤立术。1例未破裂动脉瘤，DSA显示MCA分叉部大型动脉瘤位，MCA M2段下干粗大，上干纤细，上干起始部均成为瘤颈的一部分，先行STA-MCA分流术，再行动脉瘤夹闭术。2例术后均无明显神经功能障碍，CTA示动脉瘤不显影、吻合口通畅，CTP显示脑灌注良好；术后6个月，改良Rankin量表评分0分1例，1分1例。结论 STA-MCA分流术能够延长安全临时阻断的时间，在动脉瘤孤立和载瘤动脉闭塞后提供保护性血流，在理想情况下双支STA分流术还可以提供高流量血流，替代复杂的桡动脉或大隐静脉分流术，简化手术操作。这项技术有利于提高颅内复杂动脉瘤的治愈率，降低手术并发症的发生率。
Abstract:
Objective To discuss the feasibility and effectiveness of superior temporal artery (STA)-middle cerebral artery (MCA) bypass to assist the surgical treatment of complex intracranial aneurysms. Methods The clinical data of 2 patients with complex intracranial aneurysm who underwent microsurgery in our department were analyzed retrospectively. The anastomosis between STA and M2 segment of MCA was performed prior to ligation of aneurysm in order to maintain the distal cerebral perfusion during the surgery. Results DSA showed a giant aneurysm in the posterior communicating segment of the right internal carotid artery (responsible aneurysm) and a mirror aneurysm in the posterior communicating segment of the left internal carotid artery in one patient with reptured intracranial aneurysm assocaited with bilateral embryonic posterior cerebral arteries, and a large aneurysm at the MCA bifurcation in the other patient whose M2 segment of the MCA was thick in the inferior trunk and the superior trunk was thin. There was no obvious neurological dysfunction after operation. CTA showed aneurysms obliteration with bypass patency. At 6 months after operation, the modified Rankin scale (mRS) score of 0 was achieved in one patient and mRS score of 1 in the other one patient. Conclusions STA-MCA bypass can extend the duration of temporal artery occlusion and supply protective extra blood flow to maintain normal cerebral blood perfusion. With simpler procedure and adequate blood flow supplied under ideal conditions, it has the chance to replace the radial artery or saphenous vein graft high-flow bypass with two-barrel STA bypass. STA-MCA bypass helps to improve the treatment of complex intracranial aneurysms and decrease the mortality and mobidity.

参考文献/References:

[1] Aboukais R, Verbraeken B, Leclerc X, et al. Protective STA-MCA bypass to prevent brain ischemia during high- flow bypass surgery: case series of 10 patients [J]. Acta Neurochir (Wien), 2019, 161(6): 1207-1214.
[2] Nussbaum ES, Kallmes KM, Lassig JP, et al. Cerebralrevascularization for the management of complex intra- cranial aneurysms: a single-center experience [J]. J Neuro- surg, 2018, 1-11. DOI: 10.3171/2018.4.JNS172752.
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[4] Samson D, Batjer HH, Bowman G, et al. A clinical study of the parameters and effects of temporary arterial occlusion in the management of intracranial aneurysms [J]. Neurosur-gery, 1994, 34(1): 22-28.
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[6] Surdell DL, Hage ZA, Eddleman CS, et al. Revasculariza- tion for complex intracranial aneurysms [J]. Neurosurg Focus, 2008, 24(2): E21.
[7] Cherian J, Srinivasan V, Kan P, et al. Double-barrel super- ficial temporal artery-middle cerebral artery bypass: can it be considered "high-flow" [J]? Oper Neurosurg (Hager- stown), 2018, 14(3): 288-294.
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更新日期/Last Update: 2022-06-30