颅内微小动脉瘤的经血管内栓塞治疗(附23例报告)  

Endovascular embolotherapy of very small intracranial aneurysms

作　　者：王君[1] 李宝民[1] 李生[1] 曹向宇[1] 刘新峰[1] 张阿兰[1] 葛爱莉[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《解放军医学杂志》2011年第12期1342-1344,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的分析总结血管内栓塞治疗颅内微小动脉瘤的临床效果及操作技巧。方法收集解放军总医院神经外科2007年5月-2010年6月收治的颅内微小动脉瘤患者23例(共25个瘤体),男15例,女8例,年龄23～82岁,平均48.2岁,均经全脑血管造影明确诊断并进行血管内治疗。其中20个动脉瘤采用单纯栓塞治疗,5个宽颈动脉瘤联合应用支架或球囊重塑形技术。观察治疗效果并进行术后随访。结果 25个动脉瘤中24个获得成功栓塞,其中9个(37.5%)动脉瘤一期达致密栓塞。23例患者中,术后恢复良好14例,遗留中度神经功能缺失6例,死亡2例,植物生存1例。随访3个月～3年,无再出血病例,18例复查造影,其中1例复发,给予补充致密栓塞,1例行单纯支架覆盖瘤颈的患者见动脉瘤已闭塞。结论血管内治疗微小动脉瘤安全有效。不刻意追求致密填塞、合适的栓塞技术是治疗的关键。Objective The present study analyzes the clinical effect of and the operative techniques in endovascular embolotherapy for very small intracranial aneurysms.Methods Twenty-three patients（25 tumor bodies）,composed of 15 males and 8 females,suffering from very small intracranial aneurysms were selected as subjects for the current study.They were admitted to the Neurosurgery Department of the General Hospital of Chinese PLA from May 2007 to June 2010.The patients＇ ages ranged from 23 years to 82 years,with an average of 48.2.They were all diagnosed using cerebral angiography and given endovascular treatment.The 20 aneurysms were embolized,whereas the five wide-necked aneurysms were treated using the stent or balloon remodeling technique.Effects of the treatment were observed,and postoperative follow-up was conducted.Results Out the 25 tumor bodies,24 were embolized successfully,of which 9（37.5%） were embolized tightly in the first stage.Out of the 23 patients,14 had good postoperative recovery,6 were left with varying degrees of neurological deficits,2 died,and 1 went into a persistent vegetative state.No rebleeding occurred in the follow-up within three months to three years.Eighteen cases were followed up using angiography,of which one experienced recurrence and was treated through dense embolization.Aneurysm occlusion occurred in one case of stent coverage in the neck.Conclusion Endovascular treatment is a safe and effective treatment for very small aneurysms.The key factor in the treatment is the use of appropriate embolization technology rather than the deliberate pursuit of dense packing.

关 键 词：颅内动脉瘤 栓塞 治疗性 动脉瘤 破裂 

分 类 号：R651.122[医药卫生—外科学]