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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2022, Vol. 08 ›› Issue (01) : 39 -43. doi: 10.3877/cma.j.issn.2095-9141.2022.01.008

短篇论著

血管内介入治疗合并单侧烟雾病的前交通动脉瘤
徐建军1, 王宏磊1, 乔萌1, 冯颖利1, 徐宁1,†()   
  1. 1. 130021　长春，吉林大学第一医院神经血管病外科
  • 收稿日期:2021-03-05 出版日期:2022-02-15
  • 通信作者: 徐宁

Endovascular interventional treatment of anterior communicating aneurysm with unilateral moyamoya disease

Jianjun Xu1, Honglei Wang1, Meng Qiao1, Yingli Feng1, Ning Xu1,†()   

  1. 1. Department of Vascular Neurosurgery, First Hospital of Jilin University, Changchun 130021, China
  • Received:2021-03-05 Published:2022-02-15
  • Corresponding author: Ning Xu
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徐建军, 王宏磊, 乔萌, 冯颖利, 徐宁. 血管内介入治疗合并单侧烟雾病的前交通动脉瘤[J]. 中华神经创伤外科电子杂志, 2022, 08(01): 39-43.

Jianjun Xu, Honglei Wang, Meng Qiao, Yingli Feng, Ning Xu. Endovascular interventional treatment of anterior communicating aneurysm with unilateral moyamoya disease[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(01): 39-43.

目的

探讨血管内介入治疗合并单侧烟雾病（MMD）的前交通动脉瘤临床效果。

方法

回顾性分析吉林大学第一医院神经血管病外科自2017年1月至2019年12月行血管内介入治疗的8例合并单侧MMD的前交通动脉瘤患者的临床资料，观察其栓塞方法、术后效果及随访结果。

结果

7例患者成功实施动脉瘤栓塞术，均顺利出院；1例动脉瘤术中破裂，术后死亡。临床及影像学随访6~10个月，平均（7.9±1.4）个月，7例患者均恢复良好，动脉瘤均未复发。

结论

血管内介入治疗合并单侧MMD的前交通动脉临床效果良好，是一种相对安全、有效的方法，其临床效果仍需长期随访及更多病例进一步证实。

关键词: 单侧烟雾病, 前交通动脉瘤, 血管内介入治疗
Objective

To investigate the clinical effect of intravascular interventional treatment of anterior communicating aneurysm with unilateral moyamoya disease (MMD).

Methods

The clinical data of 8 cases of anterior communicating artery aneurysm with unilateral MMD who underwent intravascular interventional therapy in Vascular Neurosurgery Department of First Hospital of Jilin University were analyzed retrospectively from January 2017 to December 2019. The embolization method, postoperative effect and follow-up results were observed.

Results

Seven patients underwent successful embolization of aneurysm and were discharged after the operation; one aneurysm ruptured during the operation and died after the operation. The clinical and imaging follow-up ranged from 6 to 10 months, with an average of (7.9±1.4) months. Seven patients recovered well, none of the aneurysms recurred.

Conclusion

Endovascular interventional treatment of anterior communicating artery with unilateral MMD has a good clinical effect. It is a relatively safe and effective method. Its clinical effect still needs to be further confirmed by long-term follow-up and more cases.

Key words: Unilateral moyamoya disease, Anterior communicating aneurysm, Endovascular interventional therapy
表1 8例合并单侧烟雾病的前交通动脉患者的基本临床资料
患者编号 性别 年龄（岁） 起病方式 烟雾病侧别 动脉瘤侧别 铃木分期 Hunt-Hess分级
1 男 64 SAH 左 左 Ⅲ Ⅱ
2 女 69 脑缺血 左 左 Ⅳ 0
3 男 57 SAH 右 右 Ⅲ Ⅱ
4 女 52 SAH 右 左 Ⅳ Ⅲ
5 女 54 SAH 右 左 Ⅲ Ⅱ
6 男 47 SAH 左 左 Ⅳ Ⅱ
7 男 64 SAH 左 右 Ⅴ Ⅰ
8 男 45 脑缺血 右 右 Ⅱ 0
表2 8例合并单侧烟雾病的前交通动脉瘤患者的治疗及随访资料
患者编号 栓塞方式 并发症 术后即刻效果（Raymond分级） 出院时评分（mRs评分） 随访时间（月） 影像学随访（Raymond分级） 临床随访（mRs评分）
1 单纯弹簧圈栓塞 一过性失语 Ⅰ 3 10 Ⅰ 1
2 支架辅助栓塞 无 Ⅰ 1 6 Ⅰ 0
3 单纯弹簧圈栓塞 无 Ⅱ 2 6 Ⅱ 1
4 单纯弹簧圈栓塞 术中破裂 Ⅱ 死亡 - - -
5 单纯弹簧圈栓塞 无 Ⅰ 3 7 Ⅰ 1
6 单纯弹簧圈栓塞 无 Ⅱ 2 8 Ⅰ 0
7 支架辅助栓塞 无 Ⅱ 2 8 Ⅰ 1
8 单纯弹簧圈栓塞 无 Ⅰ 1 9 Ⅰ 0
图1 合并单侧烟雾病的前交通动脉瘤患者术前术后DSA图A：术前DSA示前交通动脉瘤，呈窄颈、囊状；右侧大脑中动脉烟雾样改变，铃木分期Ⅱ期；B：术后即刻DSA示动脉瘤栓塞致密，基本不显影，达Raymond Ⅰ级；C：术后9个月复查DSA示未见动脉瘤复发；右侧烟雾病有进展，烟雾状血管略有增多，仍为铃木分期Ⅱ期
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