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目的 报告并评价联合应用颅内外搭桥和颈内动脉球囊闭塞术治疗 2例颅内巨大宽颈动脉瘤和长期随访结果。方法 对近 4年中联合应用颅内外搭桥和载瘤动脉球囊闭塞术治疗的 2例巨大宽颈动脉瘤的治疗和随访结果进行回顾性分析。结果 2例巨大不规则形动脉瘤 ( 1例位于左颈内动脉C1、2段和大脑中动脉M 1段 ,另 1例累及右颈内动脉岩段至右大脑中动脉M1和大脑前动脉A1段 )球囊闭塞试验阳性。先行颞浅动脉 大脑中动脉搭桥术 ,术后次日行脑血管造影证实吻合口通畅后 ,用可脱性球囊在动脉瘤近端闭塞颈内动脉。治疗后并随访 3～ 4年 ,病人无任何神经系统症状出现。CT示 2例动脉瘤均有血栓形成 ,1例可见动脉瘤缩小。血管造影示吻合口通畅 ,大脑中动脉分支显影良好 ,无动脉瘤显影。结论 联合应用颅内外搭桥和载瘤动脉球囊闭塞术 ,是治疗不能单纯栓塞并且不宜直接手术的颅内巨大宽颈动脉瘤的方法之一
Objectives To report and evaluate the use of intracranial and extracorporeal bypass grafts and internal carotid artery balloon occlusion for the treatment of two cases of intracranial giant wide carotid artery aneurysms and long-term follow-up results. Methods The results of the treatment and follow-up of 2 cases of huge wide-necked carotid aneurysms treated with combined intracranial and extracranial bypass and balloon occlusion of the parent artery in the past 4 years were analyzed retrospectively. Results Two cases of large irregular aneurysms (one case was located in the left internal carotid artery C1, segment 2 and middle cerebral artery M1 segment, and the other involved the right internal carotid artery segment to the right middle cerebral artery M1 and anterior cerebral artery A1 Segment) Positive balloon occlusion test. Firstly, the superficial temporal artery was treated with middle cerebral artery bypass grafting. After the anastomosis was confirmed by cerebral angiography the next day after surgery, the internal carotid artery was occluded in the proximal end of the aneurysm with a removable balloon. After treatment and follow-up for 3 to 4 years, the patient did not have any neurological symptoms. CT showed that 2 cases of aneurysms all had thrombosis, and 1 case showed aneurysm shrinking. An angiogram showed an unobstructed anastomosis. The middle cerebral artery was well developed and no aneurysm developed. Conclusion Combined use of intracranial and extracranial bypass and balloon-occlusive artery occlusion is one of the methods to treat intracranial huge wide-necked aneurysms that cannot be embolized and is not suitable for direct operation.