Kikkawa Yuichiro, Ikeda Toshiki, Takeda Ririko, Nakajima Hiroyuki, Ogura Takeshi, Ooigawa Hidetoshi, Kurita Hiroki
Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
World Neurosurg. 2017 Sep;105:470-477. doi: 10.1016/j.wneu.2017.06.033. Epub 2017 Jun 12.
The aim of this study is to clarify the efficacy and safety of early surgery using trapping of the affected internal carotid artery (ICA) and high-flow bypass between the second portion of the middle cerebral artery and cervical external carotid artery with radial artery graft for ruptured blood blister-like aneurysms (BBAs) arising from the anterior wall of the ICA.
Medical charts of 16 consecutive patients (7 men and 9 women; mean, 59 years) with subarachnoid hemorrhage (World Federation of Neurosurgical Societies grade I, n = 2; grade II, n = 5; grade III, n = 2; grade IV, n = 4; grade V, n = 3) caused by ruptured BBA surgically treated between July 2010 and October 2015 were retrospectively reviewed. Eleven patients underwent acute surgery within 24 hours after the onset, whereas surgery was performed between 3 and 17 days after the onset because of referral delay or associated vasospasm in 5 patients. All patients underwent the same surgical procedure.
Elimination of the BBA and patency of the bypass were achieved in all patients. Postoperatively, 2 patients showed small infarction in the Heubner artery area, and 2 others suffered symptomatic vasospasm, but no patient suffered infarction in the posterior communicating/anterior choroidal artery territories. Identically, no patient showed ischemic optic neuropathy. At the last follow-up (mean, 36 months), favorable clinical outcome (good recovery or mild disability in Glasgow Outcome Scale) was achieved in 14 (88%) of the patients without rebleeding or refilling of the aneurysms.
Early surgical repair of BBAs by trapping of the affected ICA with high-flow bypass is safe and effective treatment with satisfactory midterm outcome.
本研究旨在阐明采用患侧颈内动脉（ICA）包裹术及使用桡动脉移植物在大脑中动脉第二段与颈外动脉之间进行高流量搭桥术对源自ICA前壁的破裂血泡样动脉瘤（BBA）进行早期手术的疗效及安全性。
回顾性分析2010年7月至2015年10月间接受手术治疗的16例因BBA破裂导致蛛网膜下腔出血患者（7例男性，9例女性；平均年龄59岁）的病历。其中11例患者在发病后24小时内接受急诊手术，另外5例患者因转诊延迟或合并血管痉挛在发病后3至17天接受手术。所有患者均接受相同的手术操作。
所有患者的BBA均被消除，搭桥血管通畅。术后，2例患者在Heubner动脉区域出现小面积梗死，另外2例出现症状性血管痉挛，但无一例患者在后交通动脉/脉络膜前动脉区域发生梗死。同样，无一例患者出现缺血性视神经病变。在最后一次随访时（平均36个月），14例（88%）患者获得良好的临床结局（格拉斯哥预后评分中为良好恢复或轻度残疾），且动脉瘤无再出血或再充盈。
采用患侧ICA包裹术及高流量搭桥术对BBA进行早期手术修复是一种安全有效的治疗方法，中期结局良好。
