目的:复杂动脉瘤血运重建的有效性是公认的。本研究旨在描述颅内至颅内(IC-IC)搭桥术治疗复杂颅内动脉瘤的技术特征和临床疗效。
方法:我们回顾性回顾了2006年1月至2023年9月在我们机构接受了预先计划的手术或血管内治疗和IC-IC旁路术的所有动脉瘤患者。IC-IC旁路技术包括四种策略:A型(端到端再吻合),B型(端侧再植入),C型(原位侧侧吻合),和D型(带移植血管的IC-IC旁路)。
结果:在研究期间,10例动脉瘤患者均接受了IC-IC搭桥手术.动脉瘤位于大脑中动脉(60.0%),颞前动脉(10.0%),大脑前动脉(20.0%),和椎动脉(10.0%)。囊状动脉瘤3例(30.0%),两个梭形动脉瘤(20.0%),一个夹层动脉瘤(10.0%),和四个假性动脉瘤(40.0%)。我们对5例患者(50.0%)进行了A型策略,B型对1型(10.0%),1型C型(10.0%),和D型在三个(30.0%)。在平均68.3个月期间,良好的临床结果(改良的Rankin量表评分,0-2)在所有患者中观察到。随访血管造影显示,所有患者均完全动脉瘤闭塞,十例患者中有九例(90.0%)的旁路通畅性良好。
结论:复杂动脉瘤的治疗仍然是传统手术或血管内治疗的挑战。IC-IC旁路手术是一种有用的技术,与良好的临床结果相关,用于治疗复杂的动脉瘤。
OBJECTIVE: The effectiveness of revascularization for complex aneurysms is well-established. This study aimed to describe the technical characteristics and clinical efficacy of intracranial-to-intracranial (IC-IC) bypass for the treatment of complex intracranial aneurysms.
METHODS: We retrospectively reviewed all patients with aneurysms who underwent a preplanned combination of surgical or endovascular treatment and IC-IC bypass at our institution between January 2006 and September 2023. IC-IC bypass techniques included four strategies: type A (end-to-end reanastomosis), type B (end-to-side reimplantation), type C (in situ side-to-side anastomosis), and type D (IC-IC bypass with a graft vessel).
RESULTS: During the study period, ten patients with aneurysms each underwent IC-IC bypass surgery. Aneurysms were located in the middle cerebral artery (60.0%), anterior temporal artery (10.0%), anterior cerebral artery (20.0%), and vertebral artery (10.0%). There were three saccular aneurysms (30.0%), two fusiform aneurysms (20.0%), one dissecting aneurysm (10.0%), and four pseudoaneurysms (40.0%). We performed the type A strategy on five patients (50.0%), type B on one (10.0%), type C on one (10.0%), and type D on three (30.0%). During a mean period of 68.3 months, good clinical outcomes (modified Rankin Scale score, 0-2) were observed in all patients. Follow-up angiography demonstrated complete aneurysmal obliteration in all patients and good bypass patency in nine of ten patients (90.0%).
CONCLUSIONS: The treatment of complex aneurysms remains a challenge with conventional surgical or endovascular treatments. IC-IC bypass surgery is a useful technique, associated with favorable clinical outcomes, for treating complex aneurysms.