颈外动脉-桡动脉-岩骨段颈内动脉搭桥治疗巨大高颈段动脉瘤

doi:10.6040/j.issn.1671-7554.0.2023.1021

摘要/Abstract

摘要： 目的探讨巨大高颈段颈内动脉动脉瘤的治疗策略。方法回顾性分析1例巨大高颈段颈内动脉动脉瘤患者的临床资料、手术策略及随访,回顾相关文献。结果 1例52岁男性,因“间断呛咳1年,加重伴头痛2个月”入院,DSA提示右侧巨大高颈段颈内动脉动脉瘤,行颈外动脉-桡动脉-颈内动脉岩骨段搭桥并动脉瘤孤立术,术后造影显示动脉瘤消失,桥血管通畅。术后无新发脑缺血或脑梗死,无新发神经功能障碍,原有症状显著改善。结论对于高颈段的巨大颈内动脉动脉瘤的治疗,脑血管搭桥手术仍然是有效治疗方案之一,颈外动脉-桡动脉-岩骨段颈内动脉搭桥可以很好地处理此类病变,是理想的治疗手段。

关键词: 高颈段, 巨大动脉瘤, 颈内动脉岩骨段, 搭桥

Abstract: Objective To investigate the treatment strategy of giant high cervical extracranial internal carotid artery aneurysm(EICAA). Methods The clinical data, surgical strategy and follow-up of one case were retrospectively analyzed, and the relevant literature was reviewed. Results A 52-year-old male was admitted to hospital due to “intermittent cough for 1 year, aggravation and headache for 2 months”. DSA showed a giant right high cervical EICAA. An external carotid artery-radial artery graft-internal carotid artery petrous segment bypass combined with aneurysm trapping was performed. There was no new cerebral ischemia or cerebral infarction after surgery, no new neurological dysfunction, and the original symptoms were significantly improved. Conclusion Cerebrovascular bypass surgery is still one of the effective treatment strategies for large internal carotid artery aneurysms with high cervical segments, and internal carotid artery bypass grafting in the external carotid artery-radial artery-petrosal segment can effectively deal with such lesions.

Key words: High cervical portion, Giant aneurysm, Petrous segment of internal carotid artery, Bypass

中图分类号:

R651.1

郭文强,高恺明,佟小光. 颈外动脉-桡动脉-岩骨段颈内动脉搭桥治疗巨大高颈段动脉瘤[J]. 山东大学学报 (医学版), 2024, 62(2): 96-100.

GUO Wenqiang, GAO Kaiming, TONG Xiaoguang. External carotid artery-to-petrous internal carotid artery radial artery graft bypass for giant high cervical aneurysm[J]. Journal of Shandong University (Health Sciences), 2024, 62(2): 96-100.

参考文献

[1] Théry M, Ziza V. Symptomatic extracranial internal carotid artery aneurysm deferred repair[J]. J Med Vasc, 2023, 48(2): 84-87.
[2] Sharma RK, Asiri AM, Yamada Y, et al. Extracranial internal carotid artery aneurysm - challenges in the management: a case report and review literature[J]. Asian J Neurosurg, 2019, 14(3): 970-974.
[3] Giannopoulos S, Trinidad E, Aronow H, et al. Endovascular repair of extracranial carotid artery aneurysms: a systematic review[J]. Vasc Endovascular Surg, 2020, 54(3): 254-263.
[4] Jin J, Liu Y, Shen X, et al. Endovascular and hybrid interventions for extracranial juxta-skullbase carotid artery aneurysms: experience and long-term results[J]. J Stroke Cerebrovasc Dis, 2021, 30(4): 105611. doi: 10.1016/j.jstrokecerebrovasdis.2021.105611.
[5] Radak D, Davidovic L, Vukobratov V, et al. Carotid artery aneurysms: Serbian multicentric study[J]. Ann Vasc Surg, 2007, 21(1): 23-29.
[6] Choi E, Gwon JG, Kwon SU, et al. Management strategy for extracranial carotid artery aneurysms: a single-center experience[J]. Medicine(Baltimore), 2022, 101(19): e29327. doi: 10.1097/MD.0000000000029327.
[7] Xue S, Tang X, Zhao G, et al. Contemporary outcomes of open and endovascular intervention for extracranial carotid artery aneurysms: a single centre experience[J]. Eur J Vasc Endovasc Surg, 2020, 60(3): 347-354.
[8] Hoffman ME, Squiers JJ, Hamandi M, et al. Systematic review of the influence of anatomy and aneurysm type on treatment choice and outcomes in extracranial carotid artery aneurysm[J]. Ann Vasc Surg, 2022, 83: 349-357. doi: 10.1016/j.avsg.2022.02.006.
[9] Sfyroeras GS, Nikolopoulou EA, Moulakakis KG, et al. Extracranial internal carotid artery aneurysm in a patient with marfan syndrome[J]. Ann Vasc Surg, 2019, 57(273): 7-10.
[10] Mikhaǐlov MS, Ridel VI, Musaev AB. Surgical treatment of an extracranial aneurysm of the internal carotid artery[J]. Angiol Sosud Khir, 2020, 26(3): 167-171.
[11] 杨燎, 陈忠, 王盛. 颅外段颈动脉瘤的外科治疗体会[J]. 心肺血管病杂志, 2020, 39(13): 1373-1375. YANG Liao, CHEN Zhong, WANG Sheng. Surgical treatment of extracranial carotid artery aneurysm[J]. Journal of Cardiovascular & Pulmonary Diseases, 2020, 39(13): 1373-1375.
[12] Mukherjee P, Huilgol R, Graham A, et al. Open and endovascular repair of aneurysms affecting the distal extracranial internal carotid artery: case series[J]. J Laryngol Otol, 2016, 130(Suppl 4): 29-34. doi: 10.1017/S0022215116000694.
[13] Koketsu K, Kim K, Ideguchi M, et al. High-flow bypass surgery using a radial artery graft for an extracranial internal carotid artery aneurysm: Case reports and literature review[J]. Surg Neurol Int, 2021,12:333. doi: 10.25259/SNI_408_2021.
[14] Srivastava SD, Eagleton MJ, OHara P, et al. Surgical repair of carotid artery aneurysms: a 10-year, single-center experience[J]. Ann Vasc Surg, 2010, 24(1): 100-105.
[15] 蒲佐, 倪冷. 颅外段颈动脉瘤的腔内诊疗进展[J]. 血管与腔内血管外科杂志, 2021, 7(6): 712-715. PU Zuo, NI Leng. Advances in endovascular diagnosis and treatment of extracranial carotid aneurysms[J]. Journal of Vascular and Endovascular Surgery, 2021, 7(6): 712-715.
[16] Choi E, Gwon JG, Kwon SU, et al. Management strategy for extracranial carotid artery aneurysms: a single-center experience[J]. Medicine(Baltimore), 2022,101(19): e29327. doi: 10.1097/MD.0000000000029327.
[17] Dimtza A. Aneurysms of the carotid arteries; report of two cases[J]. Angiology, 1956, 7(3): 218-227.
[18] Beall AC Jr, Crawford ES, Cooley DA, et al. Extracranial aneurysms of the carotid artery. Report of seven cases[J]. Postgrad Med, 1962, 32: 93-102. doi: 10.1080/00325481.1962.11692659.
[19] Hamasaki R, Yanagisawa T, Takahashi Y,et al. Surgical treatment of cervical carotid artery aneurysm[J]. No Shinkei Geka, 2017, 45(8): 677-683.
[20] Fisch U. Infratemporal fossa approach to tumours of the temporal bone and base of the skull[J]. J Laryngol Otol, 1978, 92(11): 949-967.
[21] Fisch UP, Oldring DJ, Senning A. Surgical therapy of internal carotid artery lesions of the skull base and temporal bone[J]. Otolaryngol Head Neck Surg(1979), 1980, 88(5): 548-554.
[22] Angiletta D, Pulli R, Marinazzo D, et al. Surgical and endovascular treatment of extracranial carotid artery aneurysms: early and long-term results of a single center[J]. Ann Vasc Surg, 2014, 28(3): 659-664.
[23] Akinduro OO, Gopal N, Hasan TF, et al. Pipeline embolization device for treatment of extracranial internal carotid artery pseudoaneurysms: a multicenter evaluation of safety and efficacy[J]. Neurosurgery, 2020, 87(4): 770-778.
[24] Zaidi ST, George MJ, Cambiaghi T, et al. Transcarotid stenting of extracranial carotid artery aneurysm with covered stents and flow reversal[J]. J Vasc Surg Cases Innov Tech, 2023, 9(4): 101347. doi: 10.1016/j.jvscit.2023.101347.
[25] Li Z, Chang G, Yao C, et al. Endovascular stenting of extracranial carotid artery aneurysm: a systematic review[J]. Eur J Vasc Endovasc Surg, 2011, 42(4): 419-426.
[26] Heros RC. Thromboembolic complications after combined internal carotid ligation and extra-to-intracranial bypass[J]. Surg Neurol, 1984, 21(1): 75-79.
[27] Li FD, Gao ZQ, Ren HL, et al. Pre-reconstruction of cervical-to-petrous internal carotid artery: an improved technique for treatment of vascular lesions involving internal carotid artery at the lateral skull base[J]. Head Neck, 2016,38(Suppl 1): E1562-567. doi: 10.1002/hed.24279.
[28] Wang X, Han G, Wang H, et al. Cerebral revascularization for complex middle cerebral artery aneurysms: surgical strategies and outcomes in a single center[J]. Neurosurg Rev, 2023, 46(1): 68.
[29] Sia SF, Morgan MK. High flow extracranial-to-intracranial brain bypass surgery[J]. J Clin Neurosci, 2013, 20(1): 1-5.
[30] Peeters SM, Colby GP, Kim WJ, et al. Proximal internal carotid artery occlusion and extracranial-intracranial bypass for treatment of fusiform and giant internal carotid artery aneurysms[J]. World Neurosurg, 2023, 180: e494-e495. doi: 10.1016/j.wneu.2023.09.097.
[31] Glassock ME 3rd, Smith PG, Bond AG, et al. Management of aneurysms of the petrous portion of the internal carotid artery by resection and primary anastomosis[J]. Laryngoscope, 1983, 93(11 Pt 1): 1445-1453.
[32] Sekhar LN, Schramm VL Jr., Jones NF, et al. Operative exposure and management of the petrous and upper cervical internal carotid artery[J]. Neurosurgery, 1986, 19(6): 967-982.
[33] Miyazaki S, Fukushima T, Fujimaki T. Resection of high-cervical paraganglioma with cervical-to-petrous internal carotid artery saphenous vein bypass. Report of two cases[J]. J Neurosurg, 1990, 73(1): 141-146.
[34] Spetzler RF, Fukushima T, Martin N, et al. Petrous carotid-to-intradural carotid saphenous vein graft for intracavernous giant aneurysm, tumor, and occlusive cerebrovascular disease[J]. J Neurosurg, 1990, 73(4): 496-501.
[35] Fitzpatrick BC, Spetzler RF, Ballard JL, et al. Cervical-to-petrous internal carotid artery bypass procedure. Technical note[J]. J Neurosurg, 1993, 79(1): 138-141.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed