The Role of Plastic Surgeon in Cerebral Revasculaization for Complex Intracranial Aneurysms

針對複雜性顱內動脈瘤整形外科在血管吻合所扮演的角色

陳威臣(Wei-Chen Chen) ； 李經維(Jing-Wei Lee) ； 李宜堅(E-Jian Lee)

《臺灣整形外科醫學會雜誌》 22卷1期 (2013/03) Pp. 55-61

摘要

背景：對於神經外科醫師而言利用顱內血管繞道手術來重建複雜性顱內動脈瘤是一項常見的手術，但是血管吻合的成功率往往取決於主刀者的經驗。我們認為由整形外科與神經外科醫師攜手合作可以大大改善血管暢通率與預後。目的及目標：評估針對複雜性顱內動脈瘤整形外科在血管吻合上所扮演的角色，以及顱內-顱內血管繞道手術的可行性。材料及方法：我們提出兩例顱內動脈瘤術後分別使用顱內－顱外血管繞道手術與顱內-顱內血管繞道手術來進行重建以降低術後發生大腦梗塞的可能。結果：術後利用血管攝影可以證實血管吻合的暢通性，而且病人在術後一年的追蹤都未有大腦梗塞或神經學異常狀況。結論：我們相信整形外科與神經外科攜手合作，可以改善病人的預後，而且訓練良好的整形外科醫師有更豐富的經驗來執行血管縫合手術。顱內—顱內血管繞道手術雖然手術技巧較傳統的顱內－顱外血管繞道手術高，但在適當的適應症下可以提供較多的好處。

並列摘要

Background:Cerebrovascular bypass operations followed by occlusion of complex intracranial aneurysms are relatively common procedure for neurosurgeons, but the vascular anastomosis is a demanding procedure that requires experience in microsurgical techniques. We believe that the plastic surgery/neurosurgery alliance can improve the patency of the microvascular anastomosis and clinical outcomes.Aim and Objectives:To evaluate role of plastic surgeon in cerebral revascularization for complex intracranial aneurysm and the possibility of IC-IC bypass.Materials and Methods:We report two cases who received EC-IC and IC-IC bypasses which were performed by plastic surgeon followed by occlusion of complex intracranial.Results:Postoperative angiography confirmed evident patency of the anastomosis, and there was no evidence of brain infarction or neurologic deficit after a one-year follow-up.Conclusion:We believe that the plastic surgery/neurosurgery alliance allows scope for improved outcomes in cerebrovascular bypass operations, and the well-trained plastic surgeons have extensive experience in conducting the microsurgical procedure. Although IC-IC bypass technique is more challenging technically than conventional EC-IC bypass, it has several advantages and should be considered for certain candidates.

並列關鍵字

intracranial aneurysms ； extracranial-intracranial bypass ； intracranial-intracranial bypasses