摘要
目的探讨经血管内治疗颅内大型动脉瘤的方法、结果及安全性。方法采用血管内栓塞治疗颅内大型动脉瘤病人29例。动脉瘤直径15～25 mm 15例,>25 mm 14例。22例为真性动脉瘤,其中Hunt-Hess分级Ⅰ级18例,Ⅱ级4例;行GDC栓塞12例,支架辅助GDC栓塞3例,GDC栓塞加Onyx栓塞1例,球囊闭塞载瘤动脉5例,在术前进行Matas训练过程中载瘤动脉自行闭塞1例。7例为假性动脉瘤,采用球囊加GDC栓塞载瘤动脉1例,覆膜支架置入1例,球囊闭塞载瘤动脉5例。本组行1次栓塞27例,2次栓塞1例。结果临床治愈23例,好转5例,死亡1例。术后随访3～36个月,存活28例均恢复良好,无再出血发生。行DSA复查9例,示动脉瘤完全不显影7例,复发2例(为80%栓塞病人),其中1例改行手术夹闭治疗,1例临床观察。无永久性并发症发生。结论单独或联合采用GDC、Onyx、微支架、覆膜支架及球囊等闭塞载瘤动脉,是治疗颅内大动脉瘤一种微创、安全、有效的方法。
Objective To explore the method, result and safety of endovascular treatment for large intracranial aneurysms. Methods Twenty-nine patients with large intracranial aneurysms underwent endovascular embolization. In the group, there were 15 patients whose diameter of intracranial aneurysms ranged from 15.ram to 25ram, and 14 over 25ram. In 22 true aneurysms, 18 were Hunt-Hess grade Ⅰ, and 4 were grade Ⅱ. The aneurysms were embolized with GDC （Guglielmi detachable coils） in 12 cases, embolized with GDC with assistance of Neuroform stent in 3, embolized with GDC and Onyx in 1. The parent artery was embolized with detachable balloons in 5, and the parent artery spontaneously occluded during Matas test in I case before operation. Among 7 cases of false aneurysms, the parent arteries of the aneurysms were embolized with GDC and balloons in 1 case, the covered stent was implanted in the parent artery in 1, and the parent artery was embolized with detachable balloons in 5. Once embolization was performed in 27 cases and twice in 1. Results Twenty-three patients were clinically cured, 5 achieved clinical improvements and 1 died. During a period of 3 to 36 months of follow-up, the 28 survival patients were recovered well, and there was no re-bleeding. DSA was repeated in 9 cases, which showed that the aneurysm disappeared in 7, and recurred in 2 whose aneurysm cavity was occluded with GDC by 80%. In 2 recurred patients, 1 was managed by surgical clipping operation, and the other one was clinically observed. No permanent complication occurred in the group. Conclusion Endovascular embolization by GDC, Onyx, microstent （Neuroform）, covered stent or occlusion of the parent artery with balloons is a minimal traumatic, safe and effective treatment for large intracranial anearysms.
出处
《中国微侵袭神经外科杂志》
CAS
2007年第3期114-116,共3页
Chinese Journal of Minimally Invasive Neurosurgery
关键词
颅内动脉瘤
栓塞
治疗性
intracranial aneurysm
embolization, therapeutic
