大脑中动脉瘤夹闭术后症状性脑梗死的原因分析

李壮; 张海波; 李文琦; 游慧超

doi:10.7619/jcmp.20214763

大脑中动脉瘤夹闭术后症状性脑梗死的原因分析

Analysis in causes of symptomatic cerebral infarction after middle cerebral artery aneurysm clipping

摘要

摘要:
目的分析大脑中动脉分叉处动脉瘤夹闭术后形成脑梗死的原因。
方法本研究纳入2018年3月-2020年11月湖北省第三人民医院收治的行动脉瘤夹闭手术的大脑中动脉瘤患者31例, 比较术前与术后24~48 h内患者的头颅CT或弥散加权成像(DWI)的影像资料, 判断是否存在新发脑梗死, 并结合影像与手术实际情况判断梗死原因。
结果 31例患者中, 术后有脑梗死的患者5例(脑梗死组), 无脑梗死的患者26例(无梗死组)。2组年龄、性别、基础疾病与术中阻断时间比较, 差异无统计学意义(P>0.05)。5例患者发生术后脑梗死, 包括阻断后侧支代偿不足相关梗死1例, 继发载瘤动脉狭窄相关脑梗死1例, 穿支损伤相关脑梗死1例和穿支动脉粥样硬化性疾病2例。
结论大脑中动脉分叉处动脉瘤夹闭术后脑梗死的原因多样, 其中缺乏侧支代偿、继发载瘤动脉狭窄、穿支动脉损伤及穿支动脉粥样硬化性疾病是引起术后脑梗死的主要原因。

Abstract:
Objective To analyze the causes of cerebral infarction after artery aneurysm clipping at middle cerebral artery bifurcation.
Methods This study included 31 patients with middle cerebral aneurysms who underwent aneurysm clipping surgery in the Third People′s Hospital of Hubei Province from March 2018 to November 2020.The data of brain CT or diffusion weighted imaging (DWI) images of patients before surgery and within 24 to 48 h after surgery were compared to determine whether there was new cerebral infarction, and the causes of infarction was determined by combining the image and the actual situation of surgery.
Results Of 31 patients, there were 5 patients in cerebral infarction group and 26 patients in non-infarction group.There were no significant differences in age, gender, underlying disease and intraoperative occlusion time between the two groups (P>0.05).Postoperative cerebral infarction occurred in 5 cases, including 1 case with collateral compensation-related cerebral infarction after occlusion, 1 case with carrier artery stenosis related cerebral infarction, 1 case with perforator artery injury related cerebral infarction, and 2 cases of branch atheromatous disease.
Conclusion There are various reasons for the cerebral infarction after clipping of the middle cerebral artery bifurcation aneurysm.The main causes of postoperative cerebral infarction mainly include collateral compensatory vessels, secondary carrier artery stenosis, perforator artery injury and branch atheromatous disease.

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