颅内高分级多发动脉瘤的诊断与治疗  

Diagnosis and treatment of multiple intracranial aneurysms with poor-grade

作　　者：祝斐[1] 颉奎[1] 黄新[1] 余任喜 郭光亮[1] 路遥[1] 彭智翔 

机构地区：[1]解放军171医院神经外科,九江332000

出　　处：《中国微侵袭神经外科杂志》2015年第8期361-362,共2页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的总结颅内高分级多发动脉瘤的手术夹闭及栓塞治疗经验。方法回顾性分析31例颅内多发动脉瘤共63个动脉瘤病例资料。Hunt-HessⅣ级23例,Ⅴ级8例。直接夹闭56个,介入栓塞5个,未手术2个(因小于3 mm)。结果完全夹闭53个,瘤颈残留3个。完全栓塞4个,不完全栓塞1个。GOS评分:良好13例(Hunt-HessⅣ级12例、Ⅴ级1例),中残4例(Ⅳ级2例、Ⅴ级2例),重残5例(Ⅳ级4例、Ⅴ级1例),植物生存3例(Ⅳ级2例、Ⅴ级1例),死亡6例(Ⅳ级3例、Ⅴ级3例)。结论高分级多发动脉瘤的治疗策略是采取个体化治疗原则,选择正确的手术时机和方案,可取得较好效果。Objective To summarize the experience of surgical clipping and endovascular embolization for poor-grade multiple intracranial aneurysm （MIA）. Methods Clinical data of 31 MIA patients with 63 aneurysms were analyzed retrospectively. Hunt-Hess grade IV was observed in 23 patients and grade V in 8. Surgical clipping was performed on 56 aneurysms and endovascular embolization on 5. The remaining 2 aneurysms did not receive surgery for the diameter less than 3 mm. Results Total clipping Was achieved in 53 aneurysms and neck residual in 3. Total embolization was achieved in 4 aneurysms and subtotal in 1. GOS scores were determined： good outcome was seen in 13 patients including 12 with Hunt-Hess grade IV and 1 with grade V, moderate disability in 4 including 2 with grade IV and 2 with grade V, severe disability in 5 patients including 4 with grade IV and 1 with grade V, vegetative state in 3 including 2 with grade IV and 1 with grade V and 6 died including 3 with grade IV and 3 with grade V. Conclusions The individualized treatment principle is treatment strategies for poor-grade MIA patients. Optimal surgical timing and programs can get good outcome.

关 键 词：颅内动脉瘤 多发 高分级 栓塞 治疗性 夹闭术 

分 类 号：R651.1[医药卫生—外科学]