大脑前动脉远端动脉瘤外科治疗32例临床分析  

Surgical treatment for distal anterior cerebral artery aneurysms: report of 32 cases

作　　者：修位刚[1] 张曼[2] 李定君[1,3] 胡志强[1] 黄昌仁[1] 董劲虎[1] 杨晓[1] 

机构地区：[1]泸州医学院附属医院神经外科,四川泸州646000 [2]首都医科大学北京世纪坛医院临床检验中心,北京100038 [3]成都中医药大学附属医院神经外科,成都61000

出　　处：《第三军医大学学报》2015年第1期78-82,共5页Journal of Third Military Medical University

摘　　要：目的探讨大脑前动脉远端动脉瘤（distal anterior cerebral artery aneurysms,DACAA）的诊断及治疗方式。方法回顾分析32例DACAA患者的临床资料。经CTA或/和DSA诊断,32例共发现36个动脉瘤,其中多发动脉瘤4例。根据患者的Hunt-Hess分级、脑血管痉挛情况及DACAA的解剖特点分为显微夹闭手术组及介入治疗组。22例26个动脉瘤采用显微夹闭手术,包括2例介入治疗失败患者,共夹闭动脉瘤颈25个,烧灼切除1个。余10例10个动脉瘤采用介入治疗。结果显微夹闭手术组23个动脉瘤完全夹闭,2个夹闭不全,1例载瘤动脉闭塞;介入治疗组中6例致密栓塞,1例瘤内栓塞,3例载瘤动脉闭塞。结论介入治疗适于Hunt-Hess分级Ⅲ~Ⅳ级、脑血管痉挛情况较轻、瘤颈较窄者;手术夹闭适于Hunt-Hess分级Ⅰ~Ⅱ级、脑血管痉挛情况较重、合并颅内血肿者。外科治疗易导致夹闭或栓塞不全和载瘤动脉闭塞,尤其是介入治疗更易发生,因而我们更倾向选择显微夹闭手术。Objective To investigate the diagnosis and treatment of distal anterior cerebral artery aneurysms （DACAA）. Methods Clinical data of 32 DACAA patients admitted in our hospital from January 2007 to December 2012 were collected and retrospectively analyzed. All the cases were diagnosed on a basis of computed tomography angiography （CTA） or digital subtraction angiography （DSA）. There were a total of 36 DACAA, including 4 cases of multiple aneurysms. According to the results of Hunt-Hess grade, the condition of cerebral vasospasm and the anatomical features of DACAA, the cohort were divided into microsurgical clipping group and intervention treatment group. Twenty-two cases underwent microsurgical treatment, including 2 cases failed in endovascular treatment. The necks of 25 aneurysms were clipped and only one was excised. There were 10 cases underwent embolization treatment. Results There were 23 aneurysms completely occluded and 2 aneurysms incompletely occluded. The parent artery of 1 case was occluded in the microsurgical group. There were 6 cases of dense embolism in the endovascular embolization group, 1 case of tumor embolism, and 3 cases of parent artery occlusion. Conclusion Both intervention and surgical clipping have their pros and cons. The former is suitable for Hunt-Hess grade Ⅲ to IV, mild cerebral vasospasm and narrow neck of aneurysm, while, the latter is suitable for Hunt-Hess grade I to Ⅱ , severe cerebral vasospasm and aneurysm with intracranial hematoma. Since the latter approach is prone to cause to clip or incomplete embolization, especially for the embolization treatment, we are inclined to microsurgery surgery.

关 键 词：颅内动脉瘤 大脑前动脉 显微外科治疗 介入栓塞治疗 

分 类 号：R543.5[医药卫生—心血管疾病] R651.12[医药卫生—内科学]