自膨式支架贴覆治疗症状性巨大梭状椎基底动脉瘤

摘要

目的 尝试应用自膨式微支架贴覆治疗,以对症状性椎基底动脉巨大梭状动脉瘤提供帮助.方法 回顾性分析2007年10月至2009年10月治疗的5例巨大椎基底动脉梭状动脉瘤病例.经患侧椎动脉途径送入Neuroform支架2枚和LEO支架6枚,分别贴覆成形5例巨大的椎基底动脉梭状瘤,同时对1例合并瘤体破裂局部辅助应用Orbit螺旋圈3枚栓塞止血.结果 5例手术均获成功;随访3～26个月,3例患者后组脑神经损害症状基本消失,1例患者三叉神经痛显著缓解但并发单侧轻偏瘫,1例蛛网膜下腔出血患者无复发迹象.3例获数字减影血管造影复查,2例于术后1个月和4个月复查,影像学显示瘤体原膨大部分缩小并较前形态规则;1例于术后2年复查,显示动脉瘤被支架贴覆部分形态较规则,近端原支架未贴覆到的部分瘤体有轻度扩大.结论 应用自膨式支架贴覆成形治疗症状性椎基底巨大梭状动脉瘤的方法可行,瘤体生长得到控制,近期效果较肯定.%Objective To reconstruct and affix symptomatic giant and fusiform aneurysms of vertebobasilar artery by using self-expandable stents in 5 cases with an average volume 5.5 mm × 5.0 mm × 60. 0 mm. Methods The clinical data of 5 patients who were suffered from giant and fusiform aneurysms of vertebrobasilar artery between October 2007 and October 2009 were retrospectively analyzed. Under instructing of digital subtraction angiography (DSA) images deployed the LEO and Neuroform stents for reconstructing and affixing the deferent 5 giant fusiform aneurysms of vetebrobasilar artery. And assisted embolized with 3 Orbit coils for a ruptured aneurysm to stop bleeding at the same time. Results The operative procedures were succeeded in all five cases. The damaged signs and symptoms of posterior group of cranial nerves disappeared in 3 cases by following 3 to 26 months. Trigeminal neuralgia in one case was markedly improved but a hemiparesis. One case with subarachnoid hemorrhage (SAH) showed no relapse evidence. Follow up DSA images in 3 cases demonstrated one case with a more rule modality in the part of aneurysm affixed by stent and proximal part of aneurysm in which no covering by stent revealed a mild to expand after 26 months review. And the images of postoperative DSA following 1 month and 4 months in another 2 cases displayed the imaging enlargement of part of the original aneurysm body shrink and shape the rules than the previous view. Conclusions The treatment of symptomatic huge fusiform vertebrobasilar aneurysms by using self-expandable stents is feasible, aneurysm growth is under control, short-term effects are positive.