Findlay J M, Macdonald R L, Weir B K, Grace M G
Division of Neurosurgery, University of Alberta, Edmonton, Canada.
J Neurosurg. 1991 Sep;75(3):425-32. doi: 10.3171/jns.1991.75.3.0425.
It is generally believed that surgery in the face of angiographic vasospasm is dangerous due to an increased incidence of postoperative cerebral ischemia. One theory is that arterial narrowing is exacerbated by surgical manipulation of vasospastic vessels during aneurysm dissection and clipping. This theory was tested in a primate model of cerebral vasospasm and the results reported. Six monkeys underwent baseline cerebral angiography, followed by induction of subarachnoid hemorrhage (SAH) on both sides of the circle of Willis. An equal amount of fresh autologous blood clot was placed around each internal carotid, anterior cerebral, and middle cerebral artery. Six days later, angiography was repeated and the right craniectomy was reopened for clot evacuation and surgical manipulation of the right cerebral arteries, including placement of a temporary aneurysm clip on the right middle cerebral artery. The left cerebral arteries were not exposed or manipulated, and served as controls. Twenty-four hours later angiography was repeated, then the animals were killed. Equal and significant vasospasm (greater than 40% reduction in vessel caliber compared to baseline, p less than 0.05) was seen in the middle cerebral arteries on both sides of the circle of Willis in all animals 6 and 7 days after SAH. There was no significant change in the severity of vasospasm on Day 7 compared with Day 6 in the right cerebral arteries. Increased risk of postoperative cerebral ischemia for surgery in the peak vasospasm period may be due to mechanisms other than increased arterial narrowing precipitated by surgical manipulation.
一般认为，鉴于术后脑缺血发生率增加，面对血管造影显示的血管痉挛时进行手术是危险的。一种理论认为，在动脉瘤夹闭术中对痉挛血管进行手术操作会加剧动脉狭窄。该理论在灵长类脑血管痉挛模型中进行了测试，并报告了结果。六只猴子接受了基线脑血管造影，随后在 Willis 环两侧诱导蛛网膜下腔出血（SAH）。在每条颈内动脉、大脑前动脉和大脑中动脉周围放置等量的新鲜自体血凝块。六天后，重复进行血管造影，并重新打开右侧颅骨切除术以清除血凝块并对右侧脑动脉进行手术操作，包括在右侧大脑中动脉上放置临时动脉瘤夹。左侧脑动脉未暴露或进行操作，作为对照。二十四小时后重复进行血管造影，然后处死动物。在 SAH 后 6 天和 7 天，所有动物 Willis 环两侧的大脑中动脉均出现同等程度且显著的血管痉挛（与基线相比血管管径缩小超过 40%，p < 0.05）。右侧脑动脉在第 7 天与第 6 天相比，血管痉挛严重程度无显著变化。在血管痉挛高峰期进行手术时术后脑缺血风险增加，可能是由于手术操作导致动脉狭窄增加以外的其他机制。
