颅内远端动脉瘤血管内介入治疗的临床分析

摘要

Objective To investigate the clinical effect of endovascular interventional treatment of intracranial peripheral aneurysms. Methods From January 2013 to December 2016,the clinical data of 31 patients with intracranial peripheral aneurysm admitted to the Department of Neurosurgery,Anhui Provincial Hospital were analyzed retrospectively.Among them,12 patients had saccular aneurysms,10 had narrow-neck aneurysms,and 2 lacked clear aneurysm necks;19 patients had fusiform aneurysms,they all lacked clear aneurysm necks.Ten patients with narrow-neck saccular aneurysm were treated with coil embolization, of the 2 lacked clear neck saccular aneurysms,1 was treated with stent-assisted coil embolization,1 was treated with coil occlusion of the aneurysm and parent artery;4 patients with fusiform aneurysm were treated with coil occlusion of the aneurysms and parent arteries,11 with fusiform aneurysm were treated with Onyx glue occlusion of the aneurysms and parent arteries,and 4 with fusiform aneurysm were treated with coils in combination with Onyx glue occlusion of the aneurysms and parent arteries.They were followed up for 6 to 36 months after procedure. Results All patients were successfully treated with endovascular intervention,no rebleeding cases were found.Immediate postoperative angiography showed that 11 patients with saccular aneurysm were totally occluded.The aneurysms and parent arteries in 1 patient with saccular aneurysm and 19 with fusiform aneurysm were totally occluded.The aneurysms and parent arteries of 8 patients were occluded with Onyx glue,cranial CT revealed different degrees of cerebral infarction (6 patients without new neurological deficits,2 new neurologic deficits).CT revealed cerebral infarction in 1 patient treated with coils in combination with Onyx glue for occlusion of the aneurysm and parent artery(no new neurologic deficit),other patients did not have cerebral infarction and new neurologic deficits.DSA follow-up revealed aneurysm neck recurrence in 1 patient with saccular aneurysm,no obvious aneurysm recurrence was observed in all other patients. Conclusions Endovascular treatment of intracranial peripheral aneurysms is safe and effective.Choose what specific intervention therapy base on the aneurysm morphology,location, tortuous degree of the parent artery,and the importance of the blood supply area.%目的 观察颅内远端动脉瘤血管内介入治疗的疗效. 方法 回顾性分析2013年1月至2016年12月安徽省立医院神经外科收治的31例颅内远端动脉瘤患者的临床资料,其中囊状动脉瘤12例,10例为窄颈,2例缺乏明确瘤颈;梭形动脉瘤19例,均缺乏明确瘤颈.10例窄颈囊状动脉瘤均行弹簧圈填塞瘤体,2例缺乏明确瘤颈囊状动脉瘤1例行支架辅助弹簧圈填塞瘤体,1例行弹簧圈闭塞动脉瘤及载瘤动脉;4例梭形动脉瘤行弹簧圈闭塞动脉瘤及载瘤动脉,11例梭形动脉瘤行Onyx胶闭塞动脉瘤及载瘤动脉,4例梭形动脉瘤行弹簧圈联合Onyx胶闭塞动脉瘤及载瘤动脉.术后随访6~36个月. 结果 对所有患者成功行血管内介入治疗,无再出血病例,术后即刻造影显示11例囊状动脉瘤均完全闭塞,1例囊状动脉瘤和19例梭形动脉瘤患者动脉瘤及载瘤动脉均完全闭塞.8例行Onyx胶闭塞动脉瘤及载瘤动脉患者头部CT见不同程度脑梗死发生(6例无新发神经功能缺损,2例出现新发神经功能缺损),1例弹簧圈联合Onyx胶闭塞动脉瘤及载瘤动脉患者头部CT显示脑梗死发生,但无新发神经功能缺损,其余患者未出现脑梗死及新发神经功能缺损.DSA随访发现1例囊状动脉瘤患者瘤颈复发,其余所有患者未见明显动脉瘤复发. 结论 颅内远端动脉瘤血管内介入治疗安全、有效,选择何种介入治疗方式根据动脉瘤形态、位置、载瘤动脉迂曲程度及供血区域的重要性.