颅内动脉瘤破裂出血后假性动脉瘤的影像学特征及血管内栓塞治疗

The imaging features and endovascular embolization therapy of false aneurysm After the rupture of intracranial aneurysm

目的探讨颅内动脉瘤破裂出血后在其破口周围所形成的假性动脉瘤与真性动脉瘤复合体的影像学特征及血管内治疗方法,并客观评价其治疗效果。方法对44例破裂性动脉瘤采用CT及DSA等影像学检查；并对这种真性与假性动脉瘤复合体采用电解可脱性弹簧圈进行动脉瘤囊内栓塞。结果44个破裂性动脉瘤均在其破口周围形成假性动脉瘤,按DSA的影像表现将其分为三型：其中A型9例,B型23例,C型12例。44个动脉瘤均被成功栓塞,其中真性动脉瘤腔100%闭塞者37个,95%闭塞者5个,90%闭塞者2个；9例A型与23例B型假性动脉瘤腔均未行弹簧圈填塞,12例C型中10例仅用弹簧圈疏松填塞假性动脉瘤腔,另2例用3D-GDC仅栓塞真性动脉瘤腔部分。术中并发症：动脉瘤破裂1例,脑血管痉挛2例,脑梗塞1例。术后1例复发者经二次补充填塞GDC治愈。其治疗结果根据Glasgow预后评分：Ⅰ级40例,Ⅱ级2例,Ⅲ级1例,全组死亡1例。术后随访3．60个月均无再出血。结论颅内动脉瘤破裂出血后在破口周围可以形成假性动脉瘤,其特征在DSA影像上可表现为三种类型；对这种真性与假性动脉瘤复合体采用电解可脱性弹簧圈进行血管内囊内栓塞疗效可靠。

Objective To investigate the imaging features and endovascular therapeutic methods of the false aneurism and true aneurism complex, which was formed around the crevasse after rupture and bleeding of aneurism, and evaluating the therapeutic efficacy objectively. Methods Using the imaging examinations such as CT, DSA etc. In 44 cases of ruptured aneurisms, and using the Guglielmi detachable coil （GDC） to embolized the sac of this true and false aneurysm complex. Results False aneurisms were formed around the crevasse in all the 44 cases of ruptured aneurisms. We divided aneurisms into three types by the imaging manifestation of DSA, among them, 9 eases were type A, 23 cases were type B and 12 cases were type C. 44 cases of aneurisms were all sucessfully embolized, among them, the true aneurismal lumen was 100% occluded in 37 cases, 95% occluded in 5 cases. 90% occluded in 2 cases. 9 cases of type A and 23 cases of type B of the false aneurismal lumen were not embolized by the GDC. In 12 eases of type C of the false aneurisms, 10 cases were only raritas embolized by the GDC, and the other 2 eases were only embolized the true aneurismal lumen part by the 3D-GDC. There was 1 case complicated with aneurism rupturing in operation, 2 cases complicated with cerebral vasospasm, and 1 case complicated with cerebral infarction. 1 recurrent ease was cured by secondary-complementary GDC embolization. According to the Glasgow prognosis score, the therapeutic efficacy was that： 40 patients were in grade Ⅰ , 2 eases were grade Ⅱ , 1 cases were grade Ⅲ. 1 ease died. None of them was re-bleeding with follow-up visiting for 3 to 60 months in post-operation. Conclusions There can be formed the false aneurysm around the crevasse ＇after rupture and bleeding of intracranial aneurism. Its features can be divided into three types by the imaging manifestation of DSA. The curative efl＇eet by using the GDC to endovascular embolization of the true and false aneurism complex is reliable.