颅内巨大动脉瘤  

Giant intracranial aneurysms

作　　者：许百男[1] 孙正辉[1] 

机构地区：[1]中国人民解放军总医院神经外科,北京100853

出　　处：《中华神经医学杂志》2002年第1期70-72,75,共4页Chinese Journal of Neuromedicine

摘　　要：结合作者的临床经验,本文就颅内巨大动脉瘤的病理、临床表现、影象学、手术处理等方面进行了探讨。直径大于2.5cm的动脉瘤称为巨大动脉瘤,约占颅内动脉瘤的5%。巨大动脉瘤的形成原因尚不明确。粥样硬化斑块、钙化灶及瘤内血栓在巨大动脉瘤很常见。多以蛛网膜下腔出血、颅高压、局部占位效应等表现起病。颅骨平片、CT扫描、脑血管造影、MRI对巨大动脉瘤的诊断与治疗很有价值。巨大动脉瘤的治疗较普通动脉瘤危险得多,其手术指征依赖于患者的自然病史。有症状的动脉瘤应积极手术,除非不能耐受。无症状动脉瘤手术与否应根据病人的年龄、健康状况、动脉瘤的大小部位、手术的安全性等因素综合考虑。巨大动脉瘤的外科治疗包括直接动脉瘤夹闭或切除、动脉瘤包裹术、单纯动脉瘤孤立术、近远端架桥动脉瘤旷置术、血管内栓塞等,直接动脉瘤手术最为确实但操作复杂、风险较大。手术应由经验丰富的神经血管外科医生担任。The pathology, clinical presentation, radiological diagnosis, surgical management of giant aneurysms are introduced in the article on the basis of the author's experience of surgery. Intracranial aneurysms larger than 25 mm in diameter are considered giant aneurysms, which account for about 5% of all intracranial aneurysms. What causes aneurysms to grow giant is unclear. Mural thrombus, atherosclerosis and calcification in the neck and the fundus of the lesion are common in giant aneurysms. Giant aneurysms may present with subarachnoid hemorrhage, increaced intracranial pressure, local mass effect et al. The plain skull film, CT, DSA, and MRI are helpful to the diagnosis and treatment of giant aneurysms. Treatment of these lesions is more hazardous than that of ordinary aneurysms. Indications for treatment must be based on the natural history. The prognosis of symptomatic giant aneurysms is better known to be very grave, so every effort should be made to treat it, except for the patients with advanced age or poor medical condition. The natural history of asympotomatic giant aneurysms is not well known, so whether or not treatment should be offered to these patients depends on a variety of factors such as the age and general health of patient, the size and location of aneurysm, and anticipated safety of surgical treatment. The surgical management of giant aneurysms includes direct obliteration, wrapping, proximal or/and distal arterial occlusion, extra-intra cranial bypass with ligation of parent artery, and endovascular treatment and so on. Direct removal is the most effective but very difficult and risky at operation. The operation must undergo by neurovascular experienced surgeon.

关 键 词：巨大动脉瘤 病理 手术 

分 类 号：R739.41[医药卫生—肿瘤]