摘要目的 总结高流量颅内-外血管搭桥术治疗复杂性颅内动脉瘤的疗效和经验.方法 回顾性分析2010年8月至2015年8月中南大学湘雅医院神经外科行高流量颅内-外血管搭桥术治疗的颅内动脉瘤患者的临床资料,共55例.术前15例行球囊闭塞试验(BOT)试验,其中11例无法耐受.桥血管为桡动脉、小腿或大腿段大隐静脉;供血动脉为颈总(外)动脉、上颌动脉、颞浅动脉主干;前循环均以大脑中动脉为受血动脉;后循环以大脑后动脉为受血动脉.结果 无死亡患者,所有患者术后第1天桥血管均通畅.1例术后即出现偏瘫,CT示基底节区小梗死灶,术后8d肌力达Ⅲ～Ⅳ级.2例分别在术后第3、4天桥血管(小腿段大隐静脉)闭塞,无症状;1例在术后第25天桥血管(桡动脉)闭塞.43例获6个月至52个月的随访,2例在术后6个月桥血管(小腿段大隐静脉)闭塞,但无症状.5例桥血管闭塞者均未行BOT试验.结论 高流量颅内-外血管搭桥术治疗颅内复杂性动脉瘤有效,所选供血血管均能满足供血的要求;术后早期或晚期均可发生桥血管闭塞,小腿段大隐静脉及桡动脉作为桥血管更容易发生闭塞,若代偿好可以无临床症状.

abstractsObjective To summarize the efficacy and experiences of high-flow extracranialintracranial bypass for complex intracranial aneurysms.Methods From August 2010 to August 2015,the clinical data of 55 patients with intracranial aneurysm treated with high-flow extracranial-intracranial bypasses at the Department of Neurosurgery,Xiangya Hospital,Central South University were analyzed retrospectively.Fifteen patients conducted balloon occlusion test (BOT) before procedure,and 11 of them could not tolerate it.The grafts were the radial artery,the calf or thigh saphenous vein segment;the feeding arteries were common carotid (external)) artery,maxillary artery,and superficial temporal artery trunk;the middle cerebral arteries were the blood reception arteries in anterior circulation;the posterior cerebral arteries were the blood reception arteries in posterior circulation.Results There were no death in this group of patients.The grafts of all patients were patent at day 1 after procedure.One patient had hemiplegia immediately after surgery.CT scan revealed that a small infarct was in the basal ganglia region.The muscle strength reached grade Ⅲ-Ⅳ at day 8 after surgery.The grafts (saphenous vein of the calf segment) of 2 patients were occluded at day 3 and day 4 without symptoms.The graft (radial artery) of 1 patient was occluded at day 25 after procedure.Fortythree patients were followed up for 6 months to 52 months.The grafts (saphenous veins of the calf segment) of 2 patients were occluded at 6 months after procedure without any symptoms.In 5 patients with the graft occlusion did not conduct BOT.Conclusions High-flow extracranial-intracranial bypass for the treatment of complex intracranial aneurysms is effective.All the selected feeding vessels meet the requirements of blood supply.Graft occlusion may occur early or late after surgery.As grafts,both the saphenous vein of the calf segment and radial artery are more prone to occlusion.If they are well compensated,they may not have any clinical symptoms.