高流量血管搭桥治疗颅内复杂性动脉瘤-脑外科专家顾建文教授-搜狐博客

血管搭桥可作为治疗难治性颅内复杂动脉瘤的有效方法，高流量血管搭桥方法High flow bypass graft治疗颅内复杂性颅内动脉瘤giant and complex intracranial aneurysms是一种常见的操作neurovascular technical。一般为动脉瘤破裂，Hunt和Hess分级分别为I级和II级。或者未破裂动脉瘤以头痛、脑神经压迫和脑缺血发作病。方法可用桡动脉、大隐静脉radical arteries or saphenous veins移植搭桥。需要对每位患者作出个体化治疗方案和良好的血管外科技术达到成功的治疗。根据动脉瘤的部位选择较低颅底入路，在颈外动脉与颅内动脉移植搭桥时，大隐静脉或桡动脉置入皮下通路内subcutaneous tunnel。移植动脉远端与接受动脉血管吻合external carotid arteries to the intracranial recipient arteries，包括大脑中动脉middle cerebral arteries M2段、M1段、颅内段颈内动脉、大脑后动脉posterior cerebral artery P2段、椎动脉V5段，大脑前动脉A2段。移植动脉远端与供血动脉的血管吻合可以和颈外动脉、颈内动脉internal carotid artery（C2）、椎动脉vertebral artery（V3）段、大脑前动脉anterior cerebral artery A2起始段。在搭桥完毕后，将动脉瘤近心端和远端的供血动脉结扎和夹闭，阻断动脉瘤的全部血供。对有压迫脑神经或颅内占位的颅压高的患者，将动脉瘤切除。达到移植搭桥血管畅通Revascularization，动脉瘤消失。

Image 1 (above). The upper-left panel shows a magnetic resonance angiogram (MRA) image of the patient's spontaneously dissected internal carotid artery (the normal one with good flow is shown with green arrow heads, the abnormal one with poor or "severely compromised" flow is shown with red arrow heads). The good calibre external carotid artery is shown by the large yellow arrow. This vessel will represent the "donor" artery in the operation. The upper-right panel shows the "graft" artery, namely the radial artery harvested by the vascular surgeon from the left (nondominant) forearm of this patient. The lower-left panel shows the "recipient" artery for this operation, namely the right middle cerebral artery (MCA) branch. This is where the other end of the radial artery graft will be sewn in to, in the patient's brain or right hemisphere. A green "rubber dam" has been placed under this vessel to aid visualisation during the operation, which involves tiny suturing thread that is almost invisible to the eye, requiring strong magnification by the operating microscope to see and physically handle. The panel shows the radial artery graft (RAG) after it has been sewn by the neurosurgeon into the right middle cerebral artery. Temporary microclips (TC) made of titanium are shown in place during this part of the operation; these will be removed at the conclusion of the grafting procedure. Lower-right panel: The bypass operation has now been completed. The image shows the radial artery graft (now connecting normal neck and brain arteries in this patient) under built-in fluorescence imaging of a Leica operating microscope. There is excellent flow in the graft as indicated by the bright fluorescence in it. A special, safe intravenous contrast-dye called indocyanine green or ICG has been injected into the patient in order to assess the success of the operation visually. The actual amount of blood flow in such situations, i.e., before the patient leaves the operating theatre, can also be measured using a microvascular ultrasound probe from Transonic Systems.

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最后修改于 2010-07-14 12:35 阅读(?)评论(0)

脑外科专家 顾建文教授

高流量血管搭桥治疗颅内复杂性动脉瘤

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脑外科专家顾建文教授

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