摘要
目的评价多发性颅内动脉瘤(MIA)所致的急性蛛网膜下腔出血(SAH)的立体影像诊断与治疗的效果。方法对2000年12月至2006年8月收治的133例颅内动脉瘤中21例MIA (共48个动脉瘤)病例资料进行回顾性分析。这些病例在行3D-DSA或3D-CTA检查后,应用3D工作软件进行三维重建处理作出诊断,据后处理图像来拟定栓塞治疗或外科手术方案。结果(1) 21例多发性动脉瘤伴SAH患者行3D-DSA或CTA检查(共48个动脉瘤),小于15 mm者35个(72.9%),15～25 mm者9个(18.8%),大于25 mm者4个(8.3%)。微小动脉瘤、子动脉瘤(动脉瘤壁上的小阜)、瘤体穿动脉(动脉瘤壁上的小动脉)、瘤颈和载瘤动脉的三维形态和空间关系均可清楚显示。(2)根据我们制定的MIA所在部位的区域分级标准,Ⅰ级9例(占42.9%),Ⅱ级10例(占47.6%),Ⅲ级2(占9.5%),Ⅳ级0例。级别越高者,多倾向于选择血管内治疗。本组17例,共40个动脉瘤进行了血管内治疗,其中24个100%闭塞、12个90%以上闭塞、4个因动脉瘤小导管不能到位未治。显微外科手术2例,共4个动脉瘤,3个显微镜下全部夹闭、1个术中未发现,未治2例(4个动脉瘤)。结论3D-DSA或CTA能够提高自发性SAH的MIA检出率,清楚显示MIA的三维形态和空间关系,对指导治疗有很大帮助。MIA笔者多倾向于血管内治疗,必要时栓塞治疗和外科治疗联合应用。
Objective To evaluate the effect of three diameusion-digital subtraction angiography （3D-DSA） or computed tomography angiography （CTA） on the patients with ruptured multiple intracmnial aneurysm （MIA）. Methods A retrospective study on 21 patients with MIA was performed. After scanning with 3D-DSA or 3D-CTA, three-dimensional reconstruction of MIA was carried out by 3D workstation, then the diagnosis was decided and the treatment plan （endovascular treatment or microsttrgery） was selected according to stereoscopic image of MIA. Results （1） 3D-DSA or CTA was performed in 21 patients with subarachnoid hemorrhage （SAH）, it was revealed these patients carried with 48 aneurysms, including 35 small aneurysms （ 〈 15 mm）, 9 large aneurysms （ 15-25 mm）, 4 giant aneurysms （ 〉 25 mm）. Not only micro-aneurysms and small aneurysms could be precisely showed, also the size of aneurysmal neck, the relationship of the aneurysm and the parent vessel and contiguous branches by stereoscopic image. （2） According to the standard of classification, 9 patients with MIA for grade Ⅰ （42.9%）, 10 for grade Ⅱ （47.6%）, 2 for grade Ⅲ （9.5%）, 0 for grade Ⅳ. Endovascular treatment was selected prior to microsurgery for those high grade patients. In this group, 17 patients with 40 aneurysms underwent endovascular embolotherapy with GDC coils. Twenty four aneurysms were completely occlusioned, 12 beyond 90%, 4 were left without treatment because of their small size. In microsurgery group, 3 aneurysms were totally clipped, 1 could not be found during operation. No any treatment was accepted in 2 patients with 4 aneurysms. 3D-DSA or CTA, which is very useful for the diagnosis and treatment of MIA, could improve the accuracy of diagnosis of MIA and clearly show the stereoscopic image of MIA, also the relation of sac and parent artery. For those patients with high grade MIA, endovascular treatment was selected prior to microsurgery, pro re uata, used to combine with mierosurgery.
出处
《中华急诊医学杂志》
CAS
CSCD
2007年第12期1305-1308,共4页
Chinese Journal of Emergency Medicine
