血管内治疗大脑后动脉夹层动脉瘤  

Efficacy of endovascular treatment of posterior cerebral dissecting artery aneurysms

作　　者：李辉[1] 段传志[1] 李西锋[1] 何旭英[1] 张炘[1] 方钦锐 王泽群[1] 

机构地区：[1]南方医科大学珠江医院神经外科广东省神经外科研究所广东省脑功能修复与再生重点实验室,广州510282

出　　处：《中华神经外科杂志》2015年第7期712-715,共4页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（81271315）;广东省科技计划项目f20128031800131）

摘　　要：目的总结血管内治疗大脑后动脉夹层动脉瘤的疗效。方法回顾性分析2007年1月至2014年1月南方医科大学珠江医院神经外科采用血管内治疗的8例大脑后动脉夹层动脉瘤患者的临床资料。Hunt—Hess分级Ⅰ级3例，Ⅱ级4例，Ⅲ级1例；动脉瘤位于P1段1例，P2段5例，P3段2例；动脉瘤直径4～10mm。行载瘤动脉及动脉瘤栓塞术5例，支架辅助弹簧圈栓塞3例。结果术后造影显示动脉瘤均为致密栓塞。除1例出现左侧肢体肌力下降外，其余患者均无手术相关的并发症。8例患者均获得6—12个月随访，其中7例未见动脉瘤复发；1例初次治疗后动脉瘤复发的患者，再次行载瘤动脉及动脉瘤闭塞治疗后6个月，DSA提示载瘤动脉再通，再次置入2枚弹簧圈闭塞载瘤动脉，6个月后动脉瘤再次复发。1年后改良的Rankin量表评Yto分7例，1分1例。结论血管内治疗大脑后夹层动脉瘤安全，短期疗效较好。Objective To summarize the efficacy of endovascular treatment of posterior cerebral dissecting artery aneurysms. Methods The clinical data of 8 patients with posterior cerebral dissecting artery aneurysm treated with endovascular treatment at the Department of Neurosurgery, Zhujiang Hospital, Southern Medical University from January 2007 to January 2014 were analyzed retrospectively. Hunt and Hess grade ： grade Ⅰ （ n = 3 ）, grade Ⅱ （ n = 4 ）, and grade Ⅲ（ n = 1 ）. The aneurysm of 1 patient located at the P1 segment, 5 at the P2 segment, and 2 at the P3 segment. The aneurysm diameters ranged from 4 mm to 10 ram. Five patients underwent parent artery and aneurysm embolizations and 3 underwent stent- assisted coil embolization. Results Postoperative angiography showed that all the aneurysms were packed densely. In addition to one patient experienced the left limb muscle strength decrease, other patients did not have surgery-related complications. Eight patients were followed up for 6 to 12 months, and the aneurysm recurrence was not observed in 7 of them. One patient had aneurysm recurrence after being initially treated in other hospital. After his parent artery and aneurysm being occluded for 6 months in our hospital, DSA revealed the parent artery recanalization. Another 2 coils were inserted again for occluding the parent artery. His aneurysm reoccurred after 6 months and he refused to further treatment. After 12 months, the modified Rankin scale score was 0 in 7 patients and 1 in 1 patient. Conclusion Endovascular treatment of posterior cerebral dissecting aneurysm is safe and the short-term efficacy is better.

关 键 词：大脑后动脉 血管内操作 动脉瘤 夹层 

分 类 号：R651.1[医药卫生—外科学]