To explore the treatment modality of the hemorrhagic moyamoya disease associat-ed with intracranial aneurysms.Methods The clinical data of 13 patients with hemorrhagic moyamoya disease associated with intracranial aneurysms in neurosurgery department of Tongji hospital from May 20 1 6 to May 20 1 8 were retrospectively analyzed.Results 1 3 aneurysms of the 13 patients were found,including the type of main artery involved in 8 aneurysms,the type of peripheral artery involved in 5 aneurysms.Each was responsi-ble for the bleeding.CT scan showed SAH in 8 patients,intraventricular hemorrhage in 3 patients,basal gan-glia hemorrhage broken into the ventricles in 2 patients.8 patients of main artery involved were treated by in-terventional therapy with coils and 2 cases of them were received STA-MCA bypass after endovascular thera-py.5 patients of peripheral artery involved were treated by onyx embolization in 1 case and conservative thera-py in 2 cases,then all of them received STA-MCA bypass in late period,while 2 cases received surgical clip-ping and STA-MCA bypass in one-stage.Among the 8 patients of main artery involved after endovascular therapy ,Raymond I was achieved in 5 patients,and Raymond Ⅱ was achieved in 3 patients.Among the 5 pa-tients of peripheral artery involved,the aneurysm was totally clipped in 2 surgical cases,no aneurysm left and newly infarction area in 1 case by onyx embolization.1 aneurysm was stable and 1 aneurysm disappeared after STA-MCA bypass in two cases by conservative treatment.The symptom of all the 13 cases were improved to some extent compared with the preoperative state.Conclusion The hemorrhagic moyamoya disease associated with intracranial aneurysms was not uncommon.Different and active treatment measures could achieve better effect according to the type of associated aneurysm.%目的 探讨出血性烟雾病合并颅内动脉瘤患者的治疗方式.方法 回顾性分析华中科技大学同济医学院附属同济医院神经外科自2016 年4 月-2018 年4 月共收治的 13 例出血性烟雾病合并颅内动脉瘤患者的临床资料.结果 1 3 例患者中共发现 1 3 个动脉瘤,其中8 个动脉瘤为主干动脉型,5 个为外周动脉型;所有动脉瘤均为责任动脉瘤;表现为蛛网膜下腔出血8 例,脑室内出血3 例,基底节出血破入脑室2 例.8例合并主干动脉型动脉瘤患者均行弹簧圈栓塞治疗,其中有 2 例患者后期行血管重建术;5 例合并外周动脉型动脉瘤患者,其中 1 例早期行予 Onyx胶栓塞治疗,后期行血管重建术,2 例行开颅动脉瘤夹闭及血管重建术,另外2 例早期行保守治疗,后期行血管重建术.8 例烟雾病合并主干动脉型动脉瘤患者经弹簧圈栓塞术后,5 例达到致密栓塞,3 例瘤颈部分残余;5 例烟雾病合并外周动脉型动脉瘤患者中 2 例行开颅动脉瘤夹闭及血管重建术治疗,动脉瘤夹闭完全,1 例行 Onyx胶栓塞术后未见动脉瘤残留,未出现新鲜梗死灶,2 例早期保守治疗,后期行血管重建术患者复查,其中 1 例动脉瘤稳定,另外 1 例动脉瘤消失.13 例患者术后临床症状较术前均有不同程度的改善或恢复.结论 临床上出血性烟雾病合并颅内动脉瘤患者并不少见,根据动脉瘤的类型采取不同的治疗方式和积极的治疗措施能达到更好的治疗效果.
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