大脑前动脉-胼周动脉动脉瘤血管内栓塞治疗的疗效分析  

Analysis of the efficacy of endovascular embolization of anterior cerebral artery-pericallosal artery aneurysm

作　　者：莫志晓 丁小强 王新兰 陈祖文 李吻[2] Mo Zhixiao;Ding Xiaoqiang;Wang Xinlan;Chen Zuwen;Li Wen(Department of Cerebrovascular Diseases,Qinghai Cardio-Cerebrovascular Hospital,Xining 810099,China;Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]青海省心脑血管病专科医院脑血管病科,西宁810099 [2]苏州大学附属第一医院神经外科,苏州215006

出　　处：《中华神经外科杂志》2025年第2期127-131,共5页Chinese Journal of Neurosurgery

基　　金：青海省重大科技专项(2024-SF-A2)。

摘　　要：目的探讨大脑前动脉(ACA)-胼周动脉(PA)动脉瘤血管内栓塞治疗的安全性及可行性。方法回顾性收集2019年9月至2022年12月青海省心脑血管病专科医院脑血管病科(12例)和苏州大学附属第一医院神经外科(6例)接受血管内栓塞治疗ACA-PA动脉瘤患者的临床资料,共计18例(19个动脉瘤),其中破裂动脉瘤13例。术后即刻行全脑数字减影血管造影(DSA)观察动脉瘤显影情况,并采用Raymond-Roy栓塞分级评估动脉瘤栓塞情况;术后3个月行头颅CT血管成像(CTA)检查,术后6~24个月行DSA或磁共振血管成像(MRA)检查,观察动脉瘤是否复发、支架内及载瘤动脉是否存在狭窄或闭塞;术后1年采用格拉斯哥预后分级(GOS)评估患者的预后。结果18例患者的血管内治疗均顺利完成,其中11例行支架辅助栓塞治疗,7例行单纯弹簧圈栓塞治疗。术后即刻造影Raymond-Roy栓塞分级Ⅰ级17例,Ⅱ级1例。4例患者出现围手术期并发症,其中1例患者术中因血管痉挛出现"抱管"现象,解痉治疗后好转;1例破裂动脉瘤患者支架置入后出现支架内血栓形成,1例术前胼胝体少量血肿的破裂动脉瘤患者,支架辅助治疗术后第1天胼胝体血肿较术前略增大,2例破裂动脉瘤患者(1例为术中出现"抱管"现象的患者)术后出现肺部感染,均经对症治疗后好转。术后3个月18例患者均行头颅CTA检查,术后15.50(13.25,18.00)[M(Q_(1),Q_(3))]个月16例行DSA检查,术后1年2例行MRA检查;影像学检查结果均显示动脉瘤未复发,支架内及载瘤动脉无狭窄、闭塞情况发生。术后1年GOSⅤ级17例,Ⅳ级1例。结论血管内栓塞治疗可有效闭塞ACA-PA动脉瘤,围手术期并发症较轻,术后短期不易复发。ObjectiveTo explore the safety and feasibility of endovascular embolization for anterior cerebral artery(ACA)-pericallosal artery(PA)aneurysms.MethodsWe retrospectively collected clinical data from patients who underwent endovascular embolization for ACA-PA aneurysms at the Department of Cerebrovascular Diseases,Qinghai Cardio-Cerebrovascular Hospital(12 cases)and the Department of Neurosurgery,the First Affiliated Hospital of Soochow University(6 cases)between September 2019 and December 2022.There were a total of 18 cases(19 aneurysms),of which 13 were ruptured aneurysms.Immediately following the procedure,whole-brain digital subtraction angiography(DSA)was performed to evaluate aneurysm visualization,and the Raymond-Roy embolization grading system was utilized to assess immediate postoperative embolization.Cranial CTA was conducted three months post-operation,while DSA or magnetic resonance angiography(MRA)was performed at 6 to 24 months post procedure to monitor for aneurysm recurrence and to assess any stenosis or occlusion in the stent and the parent artery.The Glasgow Outcome Scale(GOS)grade was administered one year after the procedure to evaluate the patients′outcomes.ResultsEndovascular treatment was successfully completed in 18 patients,comprising 11 cases of stent-assisted embolization and 7 cases of spring coil embolization alone.Seventeen patients presented with Raymond-Roy embolization gradeⅠ,while one patient exhibited gradeⅡon immediate postoperative imaging.Four patients experienced perioperative complications.One patient experienced tube holding due to vascular spasm during surgery,which improved after spasmolysis treatment.One patient with a ruptured aneurysm experienced in-stent thrombosis following stenting.One patient with a ruptured aneurysm and a small hematoma in the corpus callosum prior to surgery showed slight enlargement of the hematoma on the first postoperative day after stent-assisted treatment.Two patients(one patient experienced tube holding during surgery)with ruptured an

关 键 词：大脑前动脉 颅内动脉瘤 血管内操作 治疗结果 胼周动脉 

分 类 号：R65[医药卫生—外科学]