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中华脑血管病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (04) : 275 -279. doi: 10.11817/j.issn.1673-9248.2022.04.010

临床病例研究

椎动脉巨大血栓性动脉瘤复合手术治疗三例报道并文献复习
李伟1, 杨咏波1, 戴嵬1, 刘涛1, 那世杰1, 张庆荣1, 凌海平1, 陶涛1, 杭春华1,()   
  1. 1. 210008 南京大学医学院附属鼓楼医院神经外科
  • 收稿日期:2021-02-01 出版日期:2022-08-01
  • 通信作者: 杭春华
  • 基金资助:
    国家自然科学基金面上项目(81971122); 江苏省自然科学基金面上项目(BK20201113)

Strategy of hybrid surgery for giant thrombotic aneurysm of vertebral artery: three case reports and literature review

Wei Li1, Yongbo Yang1, Wei Dai1   

  • Received:2021-02-01 Published:2022-08-01
引用本文:

李伟, 杨咏波, 戴嵬, 刘涛, 那世杰, 张庆荣, 凌海平, 陶涛, 杭春华. 椎动脉巨大血栓性动脉瘤复合手术治疗三例报道并文献复习[J]. 中华脑血管病杂志(电子版), 2022, 16(04): 275-279.

Wei Li, Yongbo Yang, Wei Dai. Strategy of hybrid surgery for giant thrombotic aneurysm of vertebral artery: three case reports and literature review[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2022, 16(04): 275-279.

图1 病例1,左侧椎动脉巨大血栓性动脉瘤。图a为术前MRI示左侧桥小脑角区占位,脑干明显受压;图b为术前CT血管造影示左侧椎动脉血栓性动脉瘤;图c为术前DSA示左侧椎动脉造影;图d为术前DSA示左侧为部分型胚胎型大脑后动脉(箭头所示);图e为术前DSA示右侧胚胎型大脑后动脉(箭头所示);图f为术后CT复查示脑干占位效应消除;图g为术后DSA检查示小脑后下动脉通畅(箭头所示);图h为术后右侧椎动脉造影
图2 病例2,右侧椎动脉巨大血栓性动脉瘤合并梗阻性脑积水。图a~c为术前CT及MRI示右侧桥小脑角区巨大占位,脑干及四脑室明显受压,伴幕上梗阻性脑积水;图d、e为术前DSA正位(图d)及侧位图(图e)示右侧椎动脉血栓性动脉瘤;图f为双侧椎动脉三维DSA融合;图g、h为术中血管内球囊暂时性控制载瘤动脉远端;图i为术后即刻造影示动脉瘤消失,右侧小脑后下动脉通畅;图j为左侧椎动脉供应后循环;图k、l为术后CT示脑干占位效应及梗阻性脑积水消除
图3 病例3,左侧椎动脉巨大血栓性动脉瘤。图a为术前MRI示左侧桥小脑角区巨大占位,脑干受压;图b为术前DSA示左侧椎动脉巨大血栓性动脉瘤;图c、d为术中球囊血管内控制技术;图e为术后CT示脑干占位效应消除;图f为术后CT(骨窗相)示后颅窝重建良好;图g为术后CT血管造影示动脉瘤完全消失,右侧椎动脉供应后循环
图4 巨大血栓性动脉瘤患者术中血管内球囊暂时性控制技术示意图注:PICA为小脑后下动脉
图5 巨大血栓性动脉瘤患者术中行动脉瘤孤立+瘤内血栓清除术。图a为椎动脉近端采用暂时性瘤夹控制;图b为瘤内血栓清除,保留部分瘤壁;图c为瘤内血栓清除完毕后椎动脉远端再用瘤夹夹闭
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