Clinical Analysis On Surgical Clipping Complications For Unilateral Moyamoya Associated With Intracranial Aneurysm

Objectives:A retrospective analysis was made on clinical materials of 14 patients for unilateral moyamoya associated with intracranial aneurysm who suffered from complications after clipping surgery to explore,the features and classifications of complications,risk factors and treatment outcome.Methods:the clinical materials of 14 patients with unilateral moyamoya associated with arterial aneurysm who suffered from complications after clipping surgery in the nerve vascular surgery department of First Hospital of Jilin University from June 2013 to June 2015 were collected and analyzed.Results:1. General Materials and Operation ways of patients:The age range of 14 cases was between 34~39 years old; there were 11 male patients,3 female patients;there were 15 arterial aneurysms in 14 cases,with 1case of multiple intracranial aneurysms 9 arterial aneurysms locate in the anterior communicating artery,3 arterial aneurysms locate in the middle cerebral artery,1 in the arteria cerebri anterior A1 section,1 in the arteria cerebri anterior far-end and 1 in the arteria ophthalmica. Aneurysms of 12 cases were clipped from the normal blood vessel side(MMD offside),2 case from MMD side and also with EDAS and 1 case from MMD side.2. Detailed Materials and Settlement of Postoperative Complications(1) Detailed Materials of Complications:among 14 cases withcomplications occurrence time:from 10 hours to 6 months. GCS points at occurrence:6 cases of 8-12 points,and 8 cases of 13-15 points.Classification of complications:(1) MMD side ischemic limb paralysis;MMD side ischemic symptoms;MMD side ischemic symptoms.(2)MMD side ventricle hemorrhage;subdural hematoma in the frontotemporal top of MMD.(3)Cerebrovascular spasm,MMD side ischemic symptoms.(4)Hemorrhage in the operation area accompanied by severe edema.(5)Intracranial infection,scalp infection,epileptic seizures.(2) Treatment of Complications:(1)MMD ischemic limb paralysis and no infarction in CT occurred to 3 cases;MMD lateral ischemic symptoms and frontal local infarction in CT occurred to 1 case;these four cases recovered well after being given improved circulation and hyperbaric oxygen therapy.(2)MMD lateral ischemic symptoms and massive brain infarction occurred to2 case,since the disease condition was very serious,so no surgical intervention treatment was given and the patient died.(3) MMD lateral ventricle hemorrhage occurred to 1 case;subdural hematoma in the frontotemporal top of MMD occurred to 1 case. Since they had a small amount of bleeding,they two cases were given conservative treatment and they recovered well.(4)Brain blood vessel spasm and MMD lateral ischemic symptom occurred to1 case and the patient recovered well after being given systematic treatment.(5)Operation area bleeding with serious edema occurred to 1 case,since the disease condition was very serious,so no surgical intervention treatment wasgiven and the patient died.(6)Intracranial infection occurred to 2 cases,scalp infection occurred to 1 case and epileptic seizure occurred to 1 case.3. Follow-up ResultsIn the GOS points of half-year and one year follow-up visits:8 cases of 5points,4cases of 4 points and 2 cases of 1 score.See table 5.1 for detailed materials.Conclusion:This study has made a retrospective analysis on 14 cases for unilateral moyamoya associated with intracranial aneurysm who suffered from complications after clipping surgery and it is found that ischemic and hemorrhagic complications may occur during unilateral MMD aneurysm surgical operation treatment;some ischemic complications are hemodynamic,which can get a satisfying result after being given symptomatic treatment;but some ischemic complications are very serious,which may cause a large area of cerebral infarction,with a worse prognosis. Increased intracranial pressure which may be caused by encephaledema and vasospasm may result in acute occlusion of moyamoya side blood vessel,so as to cause serious permanent nerve injury. Unilateral MMD may also cause hemorrhagic complications,which occurred to 2 cases in this study.They are caused by smoke changed blood vessel wall fragility and hemodynamics pressure increase,but they are not serious and they recovered well after being given conservative treatment like dehydration.But theoretically,this kind of hemorrhage may cause seriousresults,which should be paid great attention.Since the blood vessel of MMD side is fragile,the compensatory ability is worse and the brain tissue elasticity is worse,so symptoms may easily occur after vasospasm and the operation region is easy to bleed.