新型液态栓塞剂Onyx治疗颅内动脉瘤的初步经验

A novel liquid embolic agent Onyx in the treatment of intracranial aneurysms:preliminary experience

目的探讨液态栓塞剂Onyx栓塞颅内动脉瘤的临床效果。方法16例颅内动脉瘤患者中小型动脉瘤5例(2例为窄颈,3例为宽颈动脉瘤),大型和巨大型动脉瘤11例(均为宽颈动脉瘤)。对15例仅用Onyx栓塞治疗,对1例弹簧圈栓塞后复发的大型动脉瘤患者再行Onyx栓塞。术后采用信访和数字减影血管造影(DSA)进行随访,时间6个月至2年。结果5例小型动脉瘤均获得100%栓塞。11例大型和巨大型动脉瘤中7例获得100%栓塞,4例获得95%左右栓塞。载瘤动脉均保持通畅。3例患者出现术后并发症,其中1例术后即发现同侧脑内血肿,1例颈内动脉海绵窦段动脉瘤患者动眼神经麻痹症状加重；1例后交通段动脉瘤患者术后出现对侧肢体轻瘫。与手术相关的致残率和致死率分别为12%和6%。对6例患者通过DSA进行了随访,其中小型动脉瘤2例、大型1例未复发,巨大型3例复发；其余9例患者均通过信访进行随访,其中8例无新发症状,1例不明原因死亡。结论单纯Onyx栓塞对小型宽颈动脉瘤近期和远期疗效均好,大型、巨大型宽颈动脉瘤近期疗效满意。

Objective To explore the therapeutic effect of Onyx （ an embolic agent） in the embolization of intracranial aneurysms. Methods 16 patients with intracranial aneurysms were treated endovascularly, 5 patients with small aneurysms （2 with a narrow-neck, 3 with a wide-neck） , and 11 patients with large or giant intracranial aneurysms （ all with wide-neck）. One patient with large aneurysm recanalized after coiling, and was retreated with Onyx, and the remaining 15 patients were treated with Onyx only. The follow-up time was 6 months to 2 years by letters or digital subtraction angiography （DSA） after the procedures. Results All the 5 small aneurysms were 100% occluded; of 11 large or giant aneurysms, 7 aneurysms were 100% occluded and 4 aneurysms were 95% occluded. All their parent arteries remained patent. Three patients had procedure-related complications： 1 patient had ipsilateral intracerebral hematoma immediately after the procedure ; and 1 patient with the internal carotid-cavernous sinus aneurysm whose oc- ulomotor paralysis worsened after the procedure ; another with internal carotid-posterior communicating ar- tery aneurysm had contralateral hemiparesis. The procedure-related morbidity and mortality were 12% and 6% , respectively. Six patients were followed up by DSA, 2 small aneurysms and 1 large aneurysm did not recur, 3 giant aneurysms recurred. The 9 remaining patients were followed-up by letters. Eight patients no new symptom occurred and one died of unknown cause. Conclusion Both short- and long-term efficacy of Onyx for small wide-necked aneurysms is good, and the short-term efficacy for large and giant widenecked aneurysms is satisfactory.