眼动脉瘤次全栓塞后的血流动力学特点及复发风险分析

摘要

目的 探讨颅内眼动脉瘤栓塞后残颈处的血流动力学特征片及其对术后复发的影响.方法 选择2007年1月-2008年7月行栓塞治疗后留有残颈的眼动脉瘤患者4例,栓塞前后均行三维脑血管造影,基于三维造影资料建立动脉瘤模型,通过计算流体力学软件采用有限元算法对术前、术后及复发时瘤颈处的血流动力学特征进行分析.结果 血流动力学分析显示,4例患者栓塞后残颈处均可见高切应力和高流速区域.3例复发的眼动脉瘤复发时血流再次进入瘤腔内的位置与高切应力区域丰相吻合.结论 眼动脉瘤栓塞后瘤颈处的高切应力、高流速区域与动脉瘤复发的位置一致.血流动力学因素在眼动脉瘤栓塞后的复发中可能具有重要作用.%Objective The present study investigates the hemodynamic features in the residual necks of subtotally embolized ophthalmic aneurysms and their influence on the recurrence after operatioa Methods Four ophthalmic aneurysm cases from January 2007 to July 2008 were studied. The aneurysms of the patients had residual necks after being embolized. Three-dimensional cerebral angiography images were taken before and after embolization, and the aneurysm modes were determined based on these images. The hemodynamic features in the residual neck before and after operation and during recurrence were analyzed by using a hydrodynamic software program and the finite-element method. Results The hemodynamic analysis shows that the residual neck had high shear stress and blood flow velocity regions after embolization in all four cases. Out of the four patients, three experienced recurrence, where blood flowed into the tumor cavity coinciding with the high shear stress regioas. Conclusions High shear stress and blood flow velocity in the residual neck of embolized ophthalmic aneurysms manifested in the location of recurrence. Thus, hemodynamic factors may have an important role in the recurrence of ophthalmic aneurysms after embolization.